- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.83 / $15,476.59 / $29,936.73
| Facility | | $11,766.83 | $15,476.59 | $29,936.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.48 / $364.78 / $3,156.58
| Facility | | $208.48 | $364.78 | $3,156.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $57.75 / $109.91 / $109.91
| Facility | AS | $57.75 | $109.91 | $109.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.35 / $528.39 / $748.74
| Facility | | $276.35 | $528.39 | $748.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |