- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $18,620.87
| Facility | | $1,905.46 | $5,623.41 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,964.78 / $19,952.62
| Facility | | $3,981.07 | $10,964.78 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,801.89 / $32,359.37
| Facility | | $489.78 | $3,801.89 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Facility | AS | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,951.21 / $10,471.29
| Facility | | $537.03 | $2,951.21 | $10,471.29 |