- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,897.79 / $12,022.64
| Facility | | $1,412.54 | $4,897.79 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $23,442.29
| Facility | | $3,548.13 | $10,471.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,754.23 / $9,332.54
| Facility | | $1,202.26 | $2,754.23 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,892.96
| Facility | | $3,019.95 | $9,120.11 | $20,892.96 |