- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,630.27 / $8,912.51
| Facility | | $1,202.26 | $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
- $1,995.26 / $3,388.44 / $19,498.45
| Facility | | $1,995.26 | $3,388.44 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $524.81 / $977.24 / $977.24
| Facility | AS | $524.81 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $11,748.98 / $21,379.62
| Facility | | $3,235.94 | $11,748.98 | $21,379.62 |