- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,495.41 / $12,882.50
| Facility | | $1,174.90 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,413.10 / $15,135.61
| Facility | | $2,884.03 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,238.72 / $5,888.44
| Facility | | $323.59 | $2,238.72 | $5,888.44 |
- 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
- $2,398.83 / $7,244.36 / $16,982.44
| Facility | | $2,398.83 | $7,244.36 | $16,982.44 |