- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,623.41 / $13,803.84
| Facility | | $1,148.15 | $5,623.41 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,918.31 / $14,454.40
| Facility | | $2,630.27 | $6,918.31 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,479.11 / $5,128.61
| Facility | | $398.11 | $1,479.11 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,912.51 / $19,054.61
| Facility | | $2,951.21 | $8,912.51 | $19,054.61 |