- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,903.03 / $6,633.26 / $13,407.33
| Facility | | $2,903.03 | $6,633.26 | $13,407.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.29 / $795.95 / $997.86
| Facility | | $663.29 | $795.95 | $997.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.82 / $800.82 / $800.82
| Facility | | $800.82 | $800.82 | $800.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.08 / $80.08 / $80.08
| Facility | AS | $80.08 | $80.08 | $80.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,010.40 / $7,421.27 / $36,336.39
| Facility | | $3,010.40 | $7,421.27 | $36,336.39 |