- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,495.41 / $11,481.54
| Facility | | $1,122.02 | $5,495.41 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $1,621.81
| Facility | | $34.67 | $398.11 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | AS | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $20,892.96 / $33,113.11
| Facility | | $9,332.54 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,762.47 / $12,022.64
| Facility | | $2,630.27 | $7,762.47 | $12,022.64 |