- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,467.37 / $6,760.83
| Facility | | $1,047.13 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $8,128.31 / $12,882.50
| Facility | | $5,248.07 | $8,128.31 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,949.84 / $11,481.54
| Facility | | $707.95 | $1,949.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.78 / $851.14 / $851.14
| Facility | AS | $173.78 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $6,918.31 / $14,125.38
| Facility | | $1,862.09 | $6,918.31 | $14,125.38 |