- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,887.56 / $22,897.69 / $46,771.99
| Facility | | $5,887.56 | $22,897.69 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,986.81 / $4,237.85 / $10,194.73
| Facility | | $2,986.81 | $4,237.85 | $10,194.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,715.28 / $3,874.42 / $8,027.35
| Facility | | $2,715.28 | $3,874.42 | $8,027.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.28 / $2,143.11 / $5,913.00
| Facility | | $1,274.28 | $2,143.11 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $318.07 / $318.07 / $318.07
| Facility | AS | $318.07 | $318.07 | $318.07 |