- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $5,463.36 / $13,841.56
| Facility | | $2,318.31 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,489.78 / $7,958.64 / $13,966.90
| Facility | | $5,489.78 | $7,958.64 | $13,966.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.09 / $1,281.28 / $2,255.48
| Facility | | $752.09 | $1,281.28 | $2,255.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $751.59 / $751.59 / $751.59
| Facility | AS | $751.59 | $751.59 | $751.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.36 / $1,876.40 / $2,598.86
| Facility | | $1,327.36 | $1,876.40 | $2,598.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |