- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,548.13 / $7,943.28
| Facility | | $1,621.81 | $3,548.13 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,288.25 / $6,456.54
| Facility | | $707.95 | $1,288.25 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.98 / $1,905.46 / $1,905.46
| Facility | AS | $194.98 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,265.80 / $11,481.54
| Facility | | $2,884.03 | $4,265.80 | $11,481.54 |