- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $9,549.93 / $14,454.40
| Facility | | $1,949.84 | $9,549.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,698.24 / $2,754.23
| Facility | | $1,288.25 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,302.69 / $19,054.61
| Facility | | $4,466.84 | $12,302.69 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $13,803.84 / $13,803.84
| Facility | | $56.23 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | AS | $1,380.38 | $1,380.38 | $1,380.38 |