- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,128.61 / $12,882.50
| Facility | | $1,348.96 | $5,128.61 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $12,589.25 / $23,988.33
| Facility | | $4,073.80 | $12,589.25 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,630.78 / $12,302.69
| Facility | | $1,348.96 | $3,630.78 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | AS | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,709.64 / $19,054.61
| Facility | | $2,951.21 | $8,709.64 | $19,054.61 |