- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,801.89 / $7,585.78
| Facility | | $1,737.80 | $3,801.89 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,412.54 / $5,128.61
| Facility | | $912.01 | $1,412.54 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.78 / $407.38 / $407.38
| Facility | AS | $218.78 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,290.87 / $5,495.41
| Facility | | $1,348.96 | $2,290.87 | $5,495.41 |