- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,265.80 / $8,511.38
| Facility | | $1,698.24 | $4,265.80 | $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
- $891.25 / $1,621.81 / $4,786.30
| Facility | | $891.25 | $1,621.81 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.47 / $446.68 / $446.68
| Facility | AS | $245.47 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,235.94 / $6,309.57
| Facility | | $1,862.09 | $3,235.94 | $6,309.57 |