- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,089.30 / $2,398.83
| Facility | | $1,258.93 | $2,089.30 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $16,595.87 / $22,908.68
| Facility | | $14,125.38 | $16,595.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | AS | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,370.32 / $9,772.37
| Facility | | $2,137.96 | $5,370.32 | $9,772.37 |