- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,128.61 / $12,022.64
| Facility | | $1,202.26 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $9,332.54 / $18,620.87
| Facility | | $3,311.31 | $9,332.54 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $7,413.10
| Facility | | $1,513.56 | $2,884.03 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |