- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,786.30 / $11,748.98
| Facility | | $1,819.70 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,182.57 / $28,840.32
| Facility | | $4,677.35 | $13,182.57 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,248.07 / $13,803.84
| Facility | | $398.11 | $5,248.07 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | AS | $354.81 | $354.81 | $354.81 |
- 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 |