- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $6,025.60 / $15,135.61
| Facility | | $1,318.26 | $6,025.60 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,232.93 / $21,379.62
| Facility | | $3,548.13 | $10,232.93 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,818.38 / $7,585.78
| Facility | | $1,230.27 | $2,818.38 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,595.87
| Facility | | $2,511.89 | $7,244.36 | $16,595.87 |