- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,691.53 / $7,943.28
| Facility | | $870.96 | $2,691.53 | $7,943.28 |
- 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
- $33,884.42 / $48,977.88 / $48,977.88
| Facility | | $33,884.42 | $48,977.88 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | AS | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,585.78 / $12,302.69
| Facility | | $4,265.80 | $7,585.78 | $12,302.69 |