- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $2,398.83
| Facility | | $1,096.48 | $1,659.59 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $10,232.93
| Facility | | $6,456.54 | $7,585.78 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,801.89 / $11,748.98
| Facility | | $2,951.21 | $3,801.89 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $8,709.64
| Facility | | $1,698.24 | $5,248.07 | $8,709.64 |