- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,235.94 / $7,413.10
| Facility | | $1,122.02 | $3,235.94 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,288.25 / $6,165.95
| Facility | | $724.44 | $1,288.25 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $501.19 / $501.19
| Facility | AS | $204.17 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,398.83 / $4,677.35
| Facility | | $1,479.11 | $2,398.83 | $4,677.35 |