- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,248.07 / $12,302.69
| Facility | | $1,819.70 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,912.51 / $16,982.44
| Facility | | $3,388.44 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,786.30 / $13,182.57
| Facility | | $323.59 | $4,786.30 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Facility | AS | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,244.36 / $16,982.44
| Facility | | $2,041.74 | $7,244.36 | $16,982.44 |