- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,888.44 / $14,125.38
| Facility | | $1,584.89 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $13,489.63 / $28,183.83
| Facility | | $3,981.07 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,801.89 / $10,715.19
| Facility | | $323.59 | $3,801.89 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | AS | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,943.28 / $17,782.79
| Facility | | $2,951.21 | $7,943.28 | $17,782.79 |