- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,677.35 / $12,302.69
| Facility | | $1,122.02 | $4,677.35 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,413.10 / $15,135.61
| Facility | | $2,818.38 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,819.70 / $6,309.57
| Facility | | $398.11 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,244.36 / $16,982.44
| Facility | | $2,041.74 | $7,244.36 | $16,982.44 |