- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,897.79 / $11,748.98
| Facility | | $1,096.48 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,511.38 / $16,218.10
| Facility | | $3,388.44 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,905.46 / $5,011.87
| Facility | | $1,071.52 | $1,905.46 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Facility | AS | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,011.87 / $12,022.64
| Facility | | $1,348.96 | $5,011.87 | $12,022.64 |