- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,786.30 / $12,589.25
| Facility | | $1,230.27 | $4,786.30 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $20,417.38
| Facility | | $3,162.28 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,511.89 / $7,244.36
| Facility | | $1,174.90 | $2,511.89 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |