- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,691.53 / $6,456.54
| Facility | | $1,258.93 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,370.32 / $9,332.54
| Facility | | $2,884.03 | $5,370.32 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $42,657.95
| Facility | | $12,589.25 | $12,589.25 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | AS | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,570.88 / $7,585.78
| Facility | | $2,754.23 | $4,570.88 | $7,585.78 |