- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,570.40 / $5,623.41
| Facility | | $1,258.93 | $2,570.40 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,445.44 / $2,691.53
| Facility | | $549.54 | $1,445.44 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $2,570.40
| Facility | | $1,202.26 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $3,715.35
| Facility | | $575.44 | $794.33 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $758.58 / $758.58
| Facility | AS | $158.49 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,951.21 / $5,370.32
| Facility | | $1,412.54 | $2,951.21 | $5,370.32 |