- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,168.69 / $7,943.28
| Facility | | $1,862.09 | $4,168.69 | $7,943.28 |
- 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
- $676.08 / $977.24 / $3,388.44
| Facility | | $676.08 | $977.24 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $851.14
| Facility | AS | $181.97 | $181.97 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,511.89 / $4,786.30
| Facility | | $1,380.38 | $2,511.89 | $4,786.30 |