- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,466.84 / $11,220.18
| Facility | | $1,202.26 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $9,120.11 / $20,892.96
| Facility | | $3,801.89 | $9,120.11 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,454.71 / $7,244.36
| Facility | | $398.11 | $2,454.71 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Facility | AS | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,943.28 / $17,782.79
| Facility | | $2,951.21 | $7,943.28 | $17,782.79 |