- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,223.00 / $9,647.21 / $18,593.91
| Facility | | $5,223.00 | $9,647.21 | $18,593.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $704.82 / $894.62
| Facility | | $587.35 | $704.82 | $894.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.68 / $686.68 / $686.68
| Facility | | $686.68 | $686.68 | $686.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.78 / $67.78 / $67.78
| Facility | AS | $67.78 | $67.78 | $67.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,705.39 / $18,066.68 / $29,708.17
| Facility | | $7,705.39 | $18,066.68 | $29,708.17 |