- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,677.35 / $11,748.98
| Facility | | $1,698.24 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,302.69 / $24,547.09
| Facility | | $4,677.35 | $12,302.69 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,897.79 / $14,454.40
| Facility | | $398.11 | $4,897.79 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | AS | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $10,232.93
| Facility | | $812.83 | $3,162.28 | $10,232.93 |