- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,570.88 / $11,220.18
| Facility | | $1,202.26 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,471.29 / $20,892.96
| Facility | | $3,890.45 | $10,471.29 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,754.23 / $7,585.78
| Facility | | $398.11 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- 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 |