- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,897.79 / $11,481.54
| Facility | | $1,288.25 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $10,715.19 / $20,892.96
| Facility | | $3,162.28 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,584.89 / $6,309.57
| Facility | | $371.54 | $1,584.89 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,248.07 / $13,489.63
| Facility | | $1,318.26 | $5,248.07 | $13,489.63 |