- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,888.44 / $14,791.08
| Facility | | $1,659.59 | $5,888.44 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $13,182.57 / $29,512.09
| Facility | | $4,168.69 | $13,182.57 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,548.13 / $14,125.38
| Facility | | $1,698.24 | $3,548.13 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Facility | AS | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $12,022.64 / $29,512.09
| Facility | | $3,715.35 | $12,022.64 | $29,512.09 |