- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,511.89 / $6,760.83
| Facility | | $812.83 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,623.41 / $9,120.11
| Facility | | $3,548.13 | $5,623.41 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $933.25 / $5,495.41
| Facility | | $524.81 | $933.25 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.54 / $501.19 / $501.19
| Facility | AS | $144.54 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $5,754.40
| Facility | | $891.25 | $3,235.94 | $5,754.40 |