- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,495.41 / $12,882.50
| Facility | | $1,380.38 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,912.51 / $17,378.01
| Facility | | $3,235.94 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,754.23 / $6,606.93
| Facility | | $831.76 | $2,754.23 | $6,606.93 |
- 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
- $1,778.28 / $6,456.54 / $15,848.93
| Facility | | $1,778.28 | $6,456.54 | $15,848.93 |