- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,623.41 / $14,125.38
| Facility | | $1,258.93 | $5,623.41 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,772.37 / $17,782.79
| Facility | | $3,388.44 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,884.03 / $8,317.64
| Facility | | $323.59 | $2,884.03 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | AS | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,888.44 / $13,182.57
| Facility | | $1,862.09 | $5,888.44 | $13,182.57 |