- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,128.61 / $12,302.69
| Facility | | $1,288.25 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,912.51 / $16,982.44
| Facility | | $3,311.31 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,137.96 / $6,918.31
| Facility | | $398.11 | $2,137.96 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,413.10 / $18,620.87
| Facility | | $2,344.23 | $7,413.10 | $18,620.87 |