- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,897.79 / $11,481.54
| Facility | | $1,862.09 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,489.63 / $28,840.32
| Facility | | $4,677.35 | $13,489.63 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $8,511.38 / $24,547.09
| Facility | | $323.59 | $8,511.38 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Facility | AS | $512.86 | $512.86 | $512.86 |
- 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 |