- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,677.35 / $8,511.38
| Facility | | $1,778.28 | $4,677.35 | $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
- $954.99 / $1,905.46 / $5,248.07
| Facility | | $954.99 | $1,905.46 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $338.84 / $616.60 / $616.60
| Facility | AS | $338.84 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,311.31 / $7,943.28
| Facility | | $2,454.71 | $3,311.31 | $7,943.28 |