- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,677.35 / $8,317.64
| Facility | | $2,187.76 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,511.89 / $3,801.89
| Facility | | $776.25 | $2,511.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $9,332.54
| Facility | | $870.96 | $1,258.93 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $239.88 / $239.88 / $4,786.30
| Facility | AS | $239.88 | $239.88 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,762.47 / $12,022.64
| Facility | | $5,495.41 | $7,762.47 | $12,022.64 |