- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,511.89 / $7,585.78
| Facility | | $707.95 | $2,511.89 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,606.93 / $9,772.37
| Facility | | $2,454.71 | $6,606.93 | $9,772.37 |
- 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
- $26,302.68 / $26,302.68 / $45,708.82
| Facility | | $26,302.68 | $26,302.68 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | AS | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,585.78 / $12,302.69
| Facility | | $4,365.16 | $7,585.78 | $12,302.69 |