- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,786.30 / $8,709.64
| Facility | | $2,187.76 | $4,786.30 | $8,709.64 |
- 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
- $1,047.13 / $1,513.56 / $9,332.54
| Facility | | $1,047.13 | $1,513.56 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.42 / $275.42 / $4,786.30
| Facility | AS | $275.42 | $275.42 | $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 |