- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,570.88 / $11,481.54
| Facility | | $1,122.02 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $20,892.96
| Facility | | $3,162.28 | $8,511.38 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,089.30 / $7,079.46
| Facility | | $954.99 | $2,089.30 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $14,125.38
| Facility | | $1,949.84 | $5,754.40 | $14,125.38 |