- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,412.54 / $8,128.31
| Facility | | $588.84 | $1,412.54 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,801.89 / $8,511.38
| Facility | | $2,344.23 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $870.96
| Facility | | $489.78 | $676.08 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $912.01 / $1,862.09
| Facility | | $741.31 | $912.01 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | AS | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |