- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $11,481.54
| Facility | | $1,819.70 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $15,488.17 / $30,199.52
| Facility | | $4,897.79 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $7,762.47 / $21,877.62
| Facility | | $323.59 | $7,762.47 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | AS | $467.74 | $467.74 | $467.74 |
- 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 |