- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,951.21 / $7,585.78
| Facility | | $1,659.59 | $2,951.21 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,128.31 / $13,489.63
| Facility | | $4,365.16 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $19,054.61 / $19,054.61
| Facility | | $54.95 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | AS | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,964.78 / $24,547.09
| Facility | | $6,456.54 | $10,964.78 | $24,547.09 |