- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.35 / $1,610.06 / $6,546.21
| Facility | | $1,030.35 | $1,610.06 | $6,546.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.29 / $1,207.55 / $1,509.44
| Facility | | $1,006.29 | $1,207.55 | $1,509.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.77 / $1,200.77 / $1,200.77
| Facility | | $1,200.77 | $1,200.77 | $1,200.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.08 / $119.08 / $119.08
| Facility | AS | $119.08 | $119.08 | $119.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,798.72 / $25,726.63 / $33,820.44
| Facility | | $11,798.72 | $25,726.63 | $33,820.44 |