- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,466.84 / $11,220.18
| Facility | | $1,174.90 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,511.38 / $16,595.87
| Facility | | $3,235.94 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,819.70 / $5,128.61
| Facility | | $398.11 | $1,819.70 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |