- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,467.37 / $7,413.10
| Facility | | $831.76 | $3,467.37 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,096.48 / $4,073.80
| Facility | | $524.81 | $1,096.48 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $645.65 / $645.65
| Facility | AS | $186.21 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $5,248.07
| Facility | | $1,819.70 | $2,398.83 | $5,248.07 |