- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,143.36 / $5,472.92 / $8,588.31
| Facility | | $3,143.36 | $5,472.92 | $8,588.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.67 / $1,050.80 / $1,313.51
| Facility | | $875.67 | $1,050.80 | $1,313.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.11 / $1,039.11 / $1,039.11
| Facility | | $1,039.11 | $1,039.11 | $1,039.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.31 / $103.31 / $103.31
| Facility | AS | $103.31 | $103.31 | $103.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,998.98 / $6,090.51 / $29,788.80
| Facility | | $3,998.98 | $6,090.51 | $29,788.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,028.63 / $20,028.63 / $20,028.63
| Facility | | $20,028.63 | $20,028.63 | $20,028.63 |