- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,623.41 / $13,182.57
| Facility | | $1,288.25 | $5,623.41 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,332.54 / $17,378.01
| Facility | | $3,715.35 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,570.40 / $7,079.46
| Facility | | $870.96 | $2,570.40 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,709.64 / $19,054.61
| Facility | | $2,884.03 | $8,709.64 | $19,054.61 |