- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,128.61 / $9,772.37
| Facility | | $1,348.96 | $5,128.61 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,772.37 / $15,488.17
| Facility | | $6,309.57 | $9,772.37 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $10,232.93
| Facility | | $1,348.96 | $4,073.80 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | AS | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |