- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,801.89 / $6,760.83
| Facility | | $1,202.26 | $3,801.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $12,589.25 / $20,892.96
| Facility | | $8,128.31 | $12,589.25 | $20,892.96 |
- 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
- $1,096.48 / $1,659.59 / $5,888.44
| Facility | | $1,096.48 | $1,659.59 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Facility | AS | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,317.64
| Facility | | $1,230.27 | $4,265.80 | $8,317.64 |