- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,715.35 / $7,762.47
| Facility | | $2,041.74 | $3,715.35 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,090.30
| Facility | | $630.96 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,479.11 / $6,309.57
| Facility | | $676.08 | $1,479.11 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $288.40 / $288.40 / $4,570.88
| Facility | AS | $288.40 | $288.40 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,677.35 / $12,022.64
| Facility | | $3,548.13 | $4,677.35 | $12,022.64 |