- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,248.07 / $12,302.69
| Facility | | $1,288.25 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,709.64 / $16,982.44
| Facility | | $3,311.31 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,454.71 / $10,232.93
| Facility | | $1,096.48 | $2,454.71 | $10,232.93 |
- 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
- $2,691.53 / $8,317.64 / $17,782.79
| Facility | | $2,691.53 | $8,317.64 | $17,782.79 |