- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,677.35 / $12,302.69
| Facility | | $1,318.26 | $4,677.35 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $17,782.79
| Facility | | $3,311.31 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,388.44 / $9,772.37
| Facility | | $323.59 | $3,388.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | AS | $204.17 | $204.17 | $204.17 |
- 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 |