- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,623.41 / $11,220.18
| Facility | | $2,089.30 | $5,623.41 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,981.07 / $5,888.44
| Facility | | $1,230.27 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,995.26 / $8,128.31
| Facility | | $1,288.25 | $1,995.26 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.13 / $1,318.26 / $1,318.26
| Facility | AS | $331.13 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,888.44 / $8,709.64
| Facility | | $4,168.69 | $5,888.44 | $8,709.64 |