- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,162.28 / $7,762.47
| Facility | | $489.78 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,912.51 / $14,125.38
| Facility | | $5,754.40 | $8,912.51 | $14,125.38 |
- 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
- $331.13 / $512.86 / $8,128.31
| Facility | | $331.13 | $512.86 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | AS | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |