- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,370.32 / $12,302.69
| Facility | | $1,737.80 | $5,370.32 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,481.54 / $22,908.68
| Facility | | $4,168.69 | $11,481.54 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,630.78 / $13,489.63
| Facility | | $602.56 | $3,630.78 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | AS | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,709.64 / $19,054.61
| Facility | | $2,951.21 | $8,709.64 | $19,054.61 |