- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,570.88 / $11,481.54
| Facility | | $1,819.70 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $8,511.38 / $16,982.44
| Facility | | $2,238.72 | $8,511.38 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $5,888.44 / $15,848.93
| Facility | | $323.59 | $5,888.44 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Facility | AS | $338.84 | $338.84 | $338.84 |
- 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 |