- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,265.80 / $8,511.38
| Facility | | $1,548.82 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,677.35 / $8,317.64
| Facility | | $2,137.96 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,258.93 / $21,379.62
| Facility | | $691.83 | $1,258.93 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.98 / $1,905.46 / $1,905.46
| Facility | AS | $194.98 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,090.30 / $5,754.40
| Facility | | $2,137.96 | $3,090.30 | $5,754.40 |