- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,754.40 / $16,982.44
| Facility | | $1,513.56 | $5,754.40 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $15,848.93 / $31,622.78
| Facility | | $5,623.41 | $15,848.93 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,165.95 / $46,773.51
| Facility | | $2,137.96 | $6,165.95 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | AS | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $9,772.37 / $26,302.68
| Facility | | $2,951.21 | $9,772.37 | $26,302.68 |