- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,495.41 / $13,803.84
| Facility | | $1,412.54 | $5,495.41 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $8,709.64 / $16,982.44
| Facility | | $2,818.38 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,754.23 / $7,585.78
| Facility | | $323.59 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,912.51 / $19,054.61
| Facility | | $2,884.03 | $8,912.51 | $19,054.61 |