- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,754.40 / $14,454.40
| Facility | | $1,348.96 | $5,754.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $10,715.19 / $20,417.38
| Facility | | $3,715.35 | $10,715.19 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,951.21 / $7,413.10
| Facility | | $1,479.11 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $15,848.93
| Facility | | $2,511.89 | $7,244.36 | $15,848.93 |