- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,036.37 / $8,425.33 / $10,381.36
| Facility | | $4,036.37 | $8,425.33 | $10,381.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.32 / $956.23 / $1,168.73
| Facility | | $708.32 | $956.23 | $1,168.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.67 / $847.67 / $847.67
| Facility | | $847.67 | $847.67 | $847.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.59 / $83.59 / $83.59
| Facility | AS | $83.59 | $83.59 | $83.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,333.33 / $19,843.18 / $24,041.57
| Facility | | $4,333.33 | $19,843.18 | $24,041.57 |