- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.32 / $3,445.84 / $8,008.50
| Facility | | $1,002.32 | $3,445.84 | $8,008.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,734.00 / $7,398.00 / $16,411.00
| Facility | | $4,734.00 | $7,398.00 | $16,411.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,196.06 / $11,138.82 / $11,245.47
| Facility | | $10,196.06 | $11,138.82 | $11,245.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.89 / $83.89 / $83.89
| Facility | AS | $83.89 | $83.89 | $83.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,171.50 / $10,874.50 / $21,518.30
| Facility | | $5,171.50 | $10,874.50 | $21,518.30 |