- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.30 / $7,838.38 / $8,763.29
| Facility | | $1,160.30 | $7,838.38 | $8,763.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,231.67 / $1,231.67 / $1,231.67
| Facility | | $1,231.67 | $1,231.67 | $1,231.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $121.47 / $121.47 / $121.47
| Facility | AS | $121.47 | $121.47 | $121.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.05 / $1,300.58 / $1,647.56
| Facility | | $1,040.05 | $1,300.58 | $1,647.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $121.47 / $121.47 / $121.47
| Facility | AS | $121.47 | $121.47 | $121.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $4,616.00 / $15,732.00
| Facility | | $3,085.00 | $4,616.00 | $15,732.00 |