- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $16,595.87
| Facility | | $1,479.11 | $6,760.83 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,481.54 / $24,547.09
| Facility | | $4,168.69 | $11,481.54 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,311.31 / $14,791.08
| Facility | | $1,445.44 | $3,311.31 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $20,417.38
| Facility | | $3,019.95 | $8,912.51 | $20,417.38 |