- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,365.16 / $11,481.54
| Facility | | $1,096.48 | $4,365.16 | $11,481.54 |
- 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
- $1,412.54 / $2,570.40 / $7,244.36
| Facility | | $1,412.54 | $2,570.40 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | AS | $141.25 | $141.25 | $141.25 |
- 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 |