- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $7,762.47
| Facility | | $1,288.25 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,511.38 / $14,125.38
| Facility | | $5,495.41 | $8,511.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $6,165.95
| Facility | | $1,096.48 | $1,659.59 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | AS | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,511.38
| Facility | | $1,230.27 | $4,265.80 | $8,511.38 |