- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,466.84 / $10,964.78
| Facility | | $1,096.48 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,585.78 / $16,595.87
| Facility | | $2,454.71 | $7,585.78 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,344.23 / $12,589.25
| Facility | | $1,202.26 | $2,344.23 | $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 |