- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,890.45 / $10,232.93
| Facility | | $1,096.48 | $3,890.45 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,585.78 / $15,848.93
| Facility | | $2,344.23 | $7,585.78 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,479.11 / $3,981.07
| Facility | | $549.54 | $1,479.11 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,897.79 / $11,748.98
| Facility | | $1,348.96 | $4,897.79 | $11,748.98 |