- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,370.32 / $13,489.63
| Facility | | $1,122.02 | $5,370.32 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,481.54 / $22,387.21
| Facility | | $3,981.07 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,630.27 / $7,244.36
| Facility | | $1,318.26 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | AS | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,182.57
| Facility | | $1,995.26 | $5,754.40 | $13,182.57 |