- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.33 / $3,743.55 / $24,641.28
| Facility | | $1,036.33 | $3,743.55 | $24,641.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.62 / $1,114.96 / $1,214.76
| Facility | | $979.62 | $1,114.96 | $1,214.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.98 / $1,047.98 / $1,047.98
| Facility | | $1,047.98 | $1,047.98 | $1,047.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.97 / $102.97 / $102.97
| Facility | AS | $102.97 | $102.97 | $102.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,560.52 / $6,560.52 / $20,457.57
| Facility | | $6,560.52 | $6,560.52 | $20,457.57 |