- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,248.07 / $11,748.98
| Facility | | $1,862.09 | $5,248.07 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $15,488.17 / $30,199.52
| Facility | | $4,897.79 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $9,332.54 / $26,915.35
| Facility | | $323.59 | $9,332.54 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | AS | $575.44 | $575.44 | $575.44 |
- 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 |