- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,128.61 / $12,302.69
| Facility | | $1,230.27 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,220.18 / $25,703.96
| Facility | | $3,981.07 | $11,220.18 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,691.53 / $11,748.98
| Facility | | $549.54 | $2,691.53 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $20,417.38
| Facility | | $3,019.95 | $8,912.51 | $20,417.38 |