- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,011.87 / $12,302.69
| Facility | | $1,122.02 | $5,011.87 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $23,988.33
| Facility | | $3,548.13 | $10,471.29 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,187.76 / $9,772.37
| Facility | | $1,023.29 | $2,187.76 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,892.96
| Facility | | $3,019.95 | $9,120.11 | $20,892.96 |