- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,786.30 / $12,022.64
| Facility | | $1,819.70 | $4,786.30 | $12,022.64 |
- 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 / $5,495.41 / $15,135.61
| Facility | | $323.59 | $5,495.41 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Facility | AS | $323.59 | $323.59 | $323.59 |
- 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 |