- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,623.41 / $14,454.40
| Facility | | $1,148.15 | $5,623.41 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,120.11 / $17,782.79
| Facility | | $3,548.13 | $9,120.11 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,137.96 / $14,454.40
| Facility | | $954.99 | $2,137.96 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | AS | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,511.38 / $18,620.87
| Facility | | $3,019.95 | $8,511.38 | $18,620.87 |