- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,570.88 / $11,481.54
| Facility | | $1,071.52 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $11,220.18 / $22,908.68
| Facility | | $4,073.80 | $11,220.18 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,290.87 / $6,025.60
| Facility | | $398.11 | $2,290.87 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |