- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $8,511.38
| Facility | | $1,288.25 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,762.47 / $12,589.25
| Facility | | $4,897.79 | $7,762.47 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,187.76 / $14,125.38
| Facility | | $831.76 | $2,187.76 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $2,398.83 / $2,398.83
| Facility | AS | $204.17 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,762.47 / $14,454.40
| Facility | | $1,949.84 | $7,762.47 | $14,454.40 |