- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $6,165.95 / $16,595.87
| Facility | | $1,258.93 | $6,165.95 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $11,748.98 / $26,915.35
| Facility | | $4,677.35 | $11,748.98 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,235.94 / $18,620.87
| Facility | | $1,122.02 | $3,235.94 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | AS | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,417.38
| Facility | | $3,019.95 | $9,120.11 | $20,417.38 |