- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,128.61 / $12,302.69
| Facility | | $1,096.48 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,549.93 / $17,782.79
| Facility | | $3,388.44 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,344.23 / $5,495.41
| Facility | | $954.99 | $2,344.23 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | AS | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,182.57
| Facility | | $1,995.26 | $5,754.40 | $13,182.57 |