- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,715.35 / $8,511.38
| Facility | | $1,258.93 | $3,715.35 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $912.01 / $9,772.37
| Facility | | $501.19 | $912.01 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $851.14 / $851.14
| Facility | AS | $138.04 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $5,370.32
| Facility | | $2,137.96 | $3,019.95 | $5,370.32 |