- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,179.39 / $7,390.75 / $29,693.27
| Facility | | $5,179.39 | $7,390.75 | $29,693.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.36 / $923.33 / $1,005.98
| Facility | | $826.36 | $923.33 | $1,005.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.39 / $890.39 / $890.39
| Facility | | $890.39 | $890.39 | $890.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.50 / $87.50 / $87.50
| Facility | AS | $87.50 | $87.50 | $87.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.78 / $7,570.10 / $20,749.07
| Facility | | $2,009.78 | $7,570.10 | $20,749.07 |