- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,677.35 / $11,748.98
| Facility | | $1,122.02 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $15,135.61 / $28,183.83
| Facility | | $4,897.79 | $15,135.61 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,454.71 / $7,244.36
| Facility | | $741.31 | $2,454.71 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,715.35
| Facility | | $295.12 | $1,202.26 | $3,715.35 |