- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,888.44 / $15,488.17
| Facility | | $1,148.15 | $5,888.44 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,481.54 / $25,703.96
| Facility | | $3,981.07 | $11,481.54 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,570.40 / $6,456.54
| Facility | | $1,258.93 | $2,570.40 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,982.44
| Facility | | $2,454.71 | $7,244.36 | $16,982.44 |