- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,691.53 / $6,456.54
| Facility | | $1,148.15 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,244.36 / $11,220.18
| Facility | | $3,801.89 | $7,244.36 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $16,982.44 / $16,982.44
| Facility | | $54.95 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | AS | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,585.78 / $12,022.64
| Facility | | $4,365.16 | $7,585.78 | $12,022.64 |