- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,888.44 / $16,595.87
| Facility | | $1,479.11 | $5,888.44 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,471.29 / $22,387.21
| Facility | | $3,630.78 | $10,471.29 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,388.44 / $10,964.78
| Facility | | $398.11 | $3,388.44 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $9,120.11 / $22,908.68
| Facility | | $2,884.03 | $9,120.11 | $22,908.68 |