- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,128.61 / $12,302.69
| Facility | | $1,230.27 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,471.29 / $20,892.96
| Facility | | $3,630.78 | $10,471.29 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,454.71 / $11,481.54
| Facility | | $1,202.26 | $2,454.71 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | AS | $131.83 | $131.83 | $131.83 |
- 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 |