- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,456.54 / $21,877.62
| Facility | | $1,905.46 | $6,456.54 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,302.69 / $29,512.09
| Facility | | $5,011.87 | $12,302.69 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $5,248.07 / $46,773.51
| Facility | | $891.25 | $5,248.07 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | AS | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $9,332.54 / $23,442.29
| Facility | | $2,951.21 | $9,332.54 | $23,442.29 |