- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,073.80 / $7,585.78
| Facility | | $1,445.44 | $4,073.80 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,760.83 / $9,772.37
| Facility | | $3,311.31 | $6,760.83 | $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
- $19,952.62 / $19,952.62 / $33,884.42
| Facility | | $19,952.62 | $19,952.62 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | AS | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,754.40 / $10,232.93
| Facility | | $3,235.94 | $5,754.40 | $10,232.93 |