- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,691.53 / $5,888.44
| Facility | | $933.25 | $2,691.53 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,011.87 / $7,413.10
| Facility | | $3,090.30 | $5,011.87 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $851.14 / $851.14
| Facility | | $39.81 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $1,584.89
| Facility | | $489.78 | $812.83 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,467.37 / $9,772.37
| Facility | | $891.25 | $3,467.37 | $9,772.37 |