- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,980.75 / $9,016.48 / $18,210.62
| Facility | | $5,980.75 | $9,016.48 | $18,210.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.13 / $1,102.24 / $1,200.89
| Facility | | $985.13 | $1,102.24 | $1,200.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.61 / $1,061.61 / $1,061.61
| Facility | | $1,061.61 | $1,061.61 | $1,061.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.24 / $104.24 / $104.24
| Facility | AS | $104.24 | $104.24 | $104.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,522.72 / $11,946.40 / $20,709.57
| Facility | | $11,522.72 | $11,946.40 | $20,709.57 |