- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,089.30 / $13,489.63
| Facility | | $562.34 | $2,089.30 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,471.29 / $15,488.17
| Facility | | $5,754.40 | $10,471.29 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $977.24
| Facility | | $354.81 | $478.63 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | AS | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,585.78 / $10,964.78
| Facility | | $3,981.07 | $7,585.78 | $10,964.78 |