- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,370.32 / $12,589.25
| Facility | | $1,348.96 | $5,370.32 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $12,022.64 / $28,840.32
| Facility | | $4,897.79 | $12,022.64 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,884.03 / $14,125.38
| Facility | | $630.96 | $2,884.03 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $9,120.11 / $21,877.62
| Facility | | $2,951.21 | $9,120.11 | $21,877.62 |