- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $7,762.47
| Facility | | $1,288.25 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,332.54 / $15,135.61
| Facility | | $6,025.60 | $9,332.54 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,047.13 / $8,511.38
| Facility | | $691.83 | $1,047.13 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | AS | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,570.88 / $8,511.38
| Facility | | $1,230.27 | $4,570.88 | $8,511.38 |