- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,786.30 / $8,317.64
| Facility | | $2,089.30 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,884.03 / $4,265.80
| Facility | | $891.25 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $9,332.54
| Facility | | $758.58 | $1,122.02 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $204.17 / $2,398.83
| Facility | AS | $204.17 | $204.17 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,079.46 / $10,964.78
| Facility | | $5,495.41 | $7,079.46 | $10,964.78 |