- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,897.79 / $7,244.36
| Facility | | $891.25 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,454.40 / $19,498.45
| Facility | | $6,456.54 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $831.76 / $933.25
| Facility | | $794.33 | $831.76 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,148.15 / $1,698.24
| Facility | | $831.76 | $1,148.15 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | AS | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,890.45 / $6,456.54
| Facility | | $1,412.54 | $3,890.45 | $6,456.54 |