- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,630.27 / $8,912.51
| Facility | | $1,258.93 | $2,630.27 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,884.03 / $19,054.61
| Facility | | $1,698.24 | $2,884.03 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $436.52 / $831.76 / $831.76
| Facility | AS | $436.52 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $11,748.98 / $20,892.96
| Facility | | $3,235.94 | $11,748.98 | $20,892.96 |