- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,248.07 / $13,489.63
| Facility | | $1,047.13 | $5,248.07 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,762.47 / $16,595.87
| Facility | | $2,951.21 | $7,762.47 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,344.23 / $17,378.01
| Facility | | $1,122.02 | $2,344.23 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | AS | $112.20 | $112.20 | $112.20 |
- 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 |