- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,801.89 / $7,762.47
| Facility | | $2,041.74 | $3,801.89 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,495.41 / $7,943.28
| Facility | | $1,659.59 | $5,495.41 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $7,079.46
| Facility | | $851.14 | $1,258.93 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $229.09 / $229.09 / $416.87
| Facility | AS | $229.09 | $229.09 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $6,025.60 / $8,709.64
| Facility | | $1,288.25 | $6,025.60 | $8,709.64 |