- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,011.87 / $8,511.38
| Facility | | $2,089.30 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,089.30 / $3,801.89
| Facility | | $776.25 | $2,089.30 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,951.21 / $5,248.07
| Facility | | $630.96 | $2,951.21 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $436.52 / $6,760.83
| Facility | | $323.59 | $436.52 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.10 / $1,548.82 / $1,548.82
| Facility | AS | $87.10 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,495.41 / $8,709.64
| Facility | | $3,467.37 | $5,495.41 | $8,709.64 |