- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,466.84 / $10,964.78
| Facility | | $1,122.02 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $17,378.01
| Facility | | $3,388.44 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,344.23 / $7,079.46
| Facility | | $398.11 | $2,344.23 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | AS | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,466.84 / $11,481.54
| Facility | | $1,513.56 | $4,466.84 | $11,481.54 |