- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,786.30 / $12,022.64
| Facility | | $1,096.48 | $4,786.30 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,715.19 / $24,547.09
| Facility | | $3,548.13 | $10,715.19 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,187.76 / $15,135.61
| Facility | | $977.24 | $2,187.76 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Facility | AS | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,892.96
| Facility | | $3,019.95 | $9,120.11 | $20,892.96 |