- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,754.40 / $15,135.61
| Facility | | $1,659.59 | $5,754.40 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $12,022.64 / $25,118.86
| Facility | | $3,890.45 | $12,022.64 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $4,168.69 / $16,595.87
| Facility | | $630.96 | $4,168.69 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | AS | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $11,481.54 / $30,199.52
| Facility | | $3,548.13 | $11,481.54 | $30,199.52 |