- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,630.78 / $6,760.83
| Facility | | $1,047.13 | $3,630.78 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $8,128.31 / $13,182.57
| Facility | | $5,248.07 | $8,128.31 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,412.54 / $7,244.36
| Facility | | $616.60 | $1,412.54 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $851.14 / $851.14
| Facility | AS | $154.88 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,317.64
| Facility | | $1,230.27 | $4,265.80 | $8,317.64 |