- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,754.40 / $14,125.38
| Facility | | $1,174.90 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,317.64 / $13,182.57
| Facility | | $5,370.32 | $8,317.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,818.38 / $8,709.64
| Facility | | $812.83 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | AS | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,511.38
| Facility | | $1,230.27 | $4,265.80 | $8,511.38 |