- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,897.79 / $16,218.10
| Facility | | $1,202.26 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $11,481.54 / $42,657.95
| Facility | | $3,548.13 | $11,481.54 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,951.21 / $25,703.96
| Facility | | $1,071.52 | $2,951.21 | $25,703.96 |
- 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
- $5,754.40 / $22,387.21 / $63,095.73
| Facility | | $5,754.40 | $22,387.21 | $63,095.73 |