- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,495.41 / $11,481.54
| Facility | | $1,288.25 | $5,495.41 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $2,570.40
| Facility | | $34.67 | $398.11 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | AS | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $20,892.96 / $33,113.11
| Facility | | $9,332.54 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,589.25 / $19,054.61
| Facility | | $4,365.16 | $12,589.25 | $19,054.61 |