- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,630.27 / $6,606.93
| Facility | | $1,122.02 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $9,120.11 / $14,791.08
| Facility | | $5,754.40 | $9,120.11 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $4,168.69
| Facility | | $870.96 | $1,318.26 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | AS | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |