- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,754.40 / $13,803.84
| Facility | | $1,318.26 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,549.93 / $18,620.87
| Facility | | $3,548.13 | $9,549.93 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $16,982.44
| Facility | | $794.33 | $3,311.31 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,585.78 / $17,782.79
| Facility | | $2,511.89 | $7,585.78 | $17,782.79 |