- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,309.57 / $19,054.61
| Facility | | $1,380.38 | $6,309.57 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $17,782.79
| Facility | | $3,388.44 | $9,120.11 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,019.95 / $14,791.08
| Facility | | $630.96 | $3,019.95 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | AS | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $9,120.11 / $23,988.33
| Facility | | $2,951.21 | $9,120.11 | $23,988.33 |