- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,128.61 / $9,772.37
| Facility | | $2,089.30 | $5,128.61 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,348.96 / $7,079.46
| Facility | | $891.25 | $1,348.96 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.47 / $436.52 / $436.52
| Facility | AS | $245.47 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,365.16 / $7,585.78
| Facility | | $3,162.28 | $4,365.16 | $7,585.78 |