- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,370.32 / $12,882.50
| Facility | | $1,096.48 | $5,370.32 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,918.31 / $17,378.01
| Facility | | $3,311.31 | $6,918.31 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,089.30 / $7,413.10
| Facility | | $776.25 | $2,089.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Facility | AS | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |