- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,786.30 / $11,748.98
| Facility | | $1,318.26 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,964.78 / $21,877.62
| Facility | | $3,801.89 | $10,964.78 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,819.70 / $7,585.78
| Facility | | $426.58 | $1,819.70 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |