- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,786.30 / $12,302.69
| Facility | | $1,819.70 | $4,786.30 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $15,488.17 / $30,199.52
| Facility | | $4,897.79 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $6,025.60 / $15,848.93
| Facility | | $398.11 | $6,025.60 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | AS | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |