- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,818.38 / $8,511.38
| Facility | | $630.96 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,715.19 / $11,220.18
| Facility | | $5,888.44 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $954.99
| Facility | | $562.34 | $812.83 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,096.48 / $1,096.48
| Facility | | $34.67 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,466.84 / $30,199.52
| Facility | | $602.56 | $4,466.84 | $30,199.52 |