- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,897.79 / $12,882.50
| Facility | | $1,071.52 | $4,897.79 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $22,387.21
| Facility | | $3,548.13 | $10,471.29 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,905.46 / $5,623.41
| Facility | | $933.25 | $1,905.46 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |