- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,570.88 / $11,481.54
| Facility | | $1,698.24 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,332.54 / $17,782.79
| Facility | | $3,630.78 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,786.30 / $13,182.57
| Facility | | $323.59 | $4,786.30 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | AS | $281.84 | $281.84 | $281.84 |
- 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 |