- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $8,912.51
| Facility | | $2,089.30 | $5,248.07 | $8,912.51 |
- 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
- $1,412.54 / $2,089.30 / $10,715.19
| Facility | | $1,412.54 | $2,089.30 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $371.54 / $371.54 / $1,621.81
| Facility | AS | $371.54 | $371.54 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,244.36 / $11,220.18
| Facility | | $5,495.41 | $7,244.36 | $11,220.18 |