- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,890.45 / $7,943.28
| Facility | | $2,041.74 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $562.34 / $32,359.37
| Facility | | $263.03 | $562.34 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.66 / $61.66 / $114.82
| Facility | AS | $61.66 | $61.66 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $17,782.79 / $33,113.11
| Facility | | $4,677.35 | $17,782.79 | $33,113.11 |