- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.12 / $12,948.03 / $28,664.36
| Facility | | $5,685.12 | $12,948.03 | $28,664.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.75 / $1,116.90 / $1,396.13
| Facility | | $930.75 | $1,116.90 | $1,396.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,104.88 / $1,104.88 / $1,104.88
| Facility | | $1,104.88 | $1,104.88 | $1,104.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.68 / $109.68 / $109.68
| Facility | AS | $109.68 | $109.68 | $109.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,326.03 / $15,730.01 / $57,936.62
| Facility | | $5,326.03 | $15,730.01 | $57,936.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,439.00 / $4,439.00 / $4,439.00
| Facility | | $4,439.00 | $4,439.00 | $4,439.00 |