- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $14,791.08
| Facility | | $1,949.84 | $5,754.40 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $13,803.84 / $28,183.83
| Facility | | $4,897.79 | $13,803.84 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,265.80 / $14,454.40
| Facility | | $398.11 | $4,265.80 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | AS | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $11,481.54 / $28,840.32
| Facility | | $3,548.13 | $11,481.54 | $28,840.32 |