- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,760.83 / $38,018.94
| Facility | | $1,445.44 | $6,760.83 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $17,782.79 / $42,657.95
| Facility | | $398.11 | $17,782.79 | $42,657.95 |
- 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
- $9,120.11 / $20,892.96 / $33,113.11
| Facility | | $9,120.11 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $5,011.87 / $10,715.19
| Facility | | $616.60 | $5,011.87 | $10,715.19 |