- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,570.88 / $11,481.54
| Facility | | $1,023.29 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,882.50 / $25,703.96
| Facility | | $4,365.16 | $12,882.50 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,290.87 / $6,606.93
| Facility | | $323.59 | $2,290.87 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |