- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,632.37 / $11,340.16 / $19,818.34
| Facility | | $7,632.37 | $11,340.16 | $19,818.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.63 / $1,010.92 / $1,101.41
| Facility | | $905.63 | $1,010.92 | $1,101.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.02 / $969.02 / $969.02
| Facility | | $969.02 | $969.02 | $969.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $96.34 / $96.34 / $96.34
| Facility | AS | $96.34 | $96.34 | $96.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,987.66 / $30,169.18 / $38,836.00
| Facility | | $6,987.66 | $30,169.18 | $38,836.00 |