- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,570.88 / $11,748.98
| Facility | | $1,023.29 | $4,570.88 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $8,709.64 / $17,782.79
| Facility | | $2,691.53 | $8,709.64 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,290.87 / $12,589.25
| Facility | | $1,202.26 | $2,290.87 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,511.38 / $18,620.87
| Facility | | $3,019.95 | $8,511.38 | $18,620.87 |