- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $12,589.25
| Facility | | $1,698.24 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $10,232.93 / $19,498.45
| Facility | | $3,388.44 | $10,232.93 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,235.94 / $11,220.18
| Facility | | $398.11 | $3,235.94 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | AS | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,912.51 / $19,054.61
| Facility | | $2,884.03 | $8,912.51 | $19,054.61 |