- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $7,762.47
| Facility | | $1,174.90 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,332.54 / $15,488.17
| Facility | | $6,025.60 | $9,332.54 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | | $15,848.93 | $15,848.93 | $15,848.93 |
- 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
- $199.53 / $5,370.32 / $5,370.32
| Facility | AS | $199.53 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,943.28 / $15,135.61
| Facility | | $1,949.84 | $7,943.28 | $15,135.61 |