- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,388.44 / $6,456.54
| Facility | | $1,318.26 | $3,388.44 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $8,128.31 / $13,489.63
| Facility | | $2,754.23 | $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
- $5,011.87 / $20,892.96 / $20,892.96
| Facility | | $5,011.87 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | AS | $2,089.30 | $2,089.30 | $2,089.30 |
- 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 |