- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,570.88 / $12,022.64
| Facility | | $1,288.25 | $4,570.88 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,120.11 / $16,982.44
| Facility | | $3,548.13 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,090.30 / $8,709.64
| Facility | | $398.11 | $3,090.30 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | AS | $218.78 | $218.78 | $218.78 |
- 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 |