- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,162.28 / $8,317.64
| Facility | | $1,412.54 | $3,162.28 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $17,782.79 / $28,840.32
| Facility | | $11,481.54 | $17,782.79 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,511.89 / $12,589.25
| Facility | | $1,047.13 | $2,511.89 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.19 / $1,905.46 / $1,905.46
| Facility | AS | $251.19 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,943.28 / $14,454.40
| Facility | | $1,949.84 | $7,943.28 | $14,454.40 |