- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,370.32 / $12,882.50
| Facility | | $1,148.15 | $5,370.32 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $11,220.18 / $22,387.21
| Facility | | $3,801.89 | $11,220.18 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,511.89 / $6,760.83
| Facility | | $1,348.96 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | AS | $134.90 | $134.90 | $134.90 |
- 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 |