- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,677.35 / $8,511.38
| Facility | | $1,380.38 | $4,677.35 | $8,511.38 |
- 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 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,995.26 / $7,943.28
| Facility | | $1,348.96 | $1,995.26 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | AS | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,370.32 / $10,471.29
| Facility | | $1,621.81 | $5,370.32 | $10,471.29 |