- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,011.87 / $26,302.68
| Facility | | $1,174.90 | $5,011.87 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,413.10 / $36,307.81
| Facility | | $3,630.78 | $7,413.10 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,019.95 / $25,703.96
| Facility | | $1,318.26 | $3,019.95 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | AS | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $17,378.01 / $45,708.82
| Facility | | $4,897.79 | $17,378.01 | $45,708.82 |