- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,715.35 / $7,943.28
| Facility | | $1,412.54 | $3,715.35 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $8,709.64
| Facility | | $2,238.72 | $4,897.79 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $758.58 / $11,220.18
| Facility | | $54.95 | $758.58 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $91.20 / $1,288.25 / $1,288.25
| Facility | AS | $91.20 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $8,709.64
| Facility | | $2,454.71 | $3,715.35 | $8,709.64 |