- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,466.84 / $10,964.78
| Facility | | $1,230.27 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,471.29 / $21,877.62
| Facility | | $3,630.78 | $10,471.29 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,344.23 / $7,413.10
| Facility | | $398.11 | $2,344.23 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | AS | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $23,988.33
| Facility | | $3,630.78 | $10,232.93 | $23,988.33 |