- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,715.35 / $9,772.37
| Facility | | $1,071.52 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,912.51 / $16,982.44
| Facility | | $3,162.28 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,445.44 / $3,890.45
| Facility | | $398.11 | $1,445.44 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | AS | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,691.53 / $6,309.57
| Facility | | $645.65 | $2,691.53 | $6,309.57 |