- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,165.95 / $6,606.93
| Facility | | $1,445.44 | $6,165.95 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $16,595.87 / $26,915.35
| Facility | | $10,715.19 | $16,595.87 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $8,317.64
| Facility | | $2,344.23 | $2,344.23 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,511.89 / $9,772.37
| Facility | | $1,659.59 | $2,511.89 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | AS | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,244.36 / $14,125.38
| Facility | | $1,949.84 | $7,244.36 | $14,125.38 |