- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,248.07 / $8,912.51
| Facility | | $2,187.76 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $16,982.44
| Facility | | $1,995.26 | $2,884.03 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $524.81 / $524.81 / $977.24
| Facility | AS | $524.81 | $524.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $10,232.93 / $18,620.87
| Facility | | $4,570.88 | $10,232.93 | $18,620.87 |