- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,481.47 / $8,928.15 / $18,431.52
| Facility | | $4,481.47 | $8,928.15 | $18,431.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.61 / $398.17 / $433.82
| Facility | | $351.61 | $398.17 | $433.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.23 / $375.23 / $375.23
| Facility | | $375.23 | $375.23 | $375.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.06 / $37.06 / $37.06
| Facility | AS | $37.06 | $37.06 | $37.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,772.14 / $12,576.35 / $27,446.60
| Facility | | $3,772.14 | $12,576.35 | $27,446.60 |