- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,786.30 / $11,481.54
| Facility | | $1,819.70 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $12,022.64 / $23,988.33
| Facility | | $4,073.80 | $12,022.64 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $7,079.46 / $19,498.45
| Facility | | $323.59 | $7,079.46 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | AS | $416.87 | $416.87 | $416.87 |
- 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 |