- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,273.23 / $4,779.89 / $6,897.96
| Facility | | $1,273.23 | $4,779.89 | $6,897.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.12 / $722.62 / $787.31
| Facility | | $654.12 | $722.62 | $787.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.86 / $1,048.86 / $1,048.86
| Facility | | $1,048.86 | $1,048.86 | $1,048.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.89 / $104.89 / $104.89
| Facility | AS | $104.89 | $104.89 | $104.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,579.33 / $4,579.33 / $4,579.33
| Facility | | $4,579.33 | $4,579.33 | $4,579.33 |