- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,128.61 / $9,772.37
| Facility | | $2,089.30 | $5,128.61 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,089.30 / $10,715.19
| Facility | | $954.99 | $2,089.30 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.87 / $223.87 / $1,621.81
| Facility | AS | $223.87 | $223.87 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $10,964.78
| Facility | | $4,570.88 | $7,079.46 | $10,964.78 |