- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,786.30 / $11,481.54
| Facility | | $1,023.29 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,165.95 / $13,803.84
| Facility | | $2,818.38 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,479.11 / $3,890.45
| Facility | | $323.59 | $1,479.11 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $93.33 / $93.33 / $93.33
| Facility | AS | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,511.38 / $17,782.79
| Facility | | $2,884.03 | $8,511.38 | $17,782.79 |