- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,466.84 / $10,964.78
| Facility | | $912.01 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,025.60 / $13,489.63
| Facility | | $2,818.38 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,380.38 / $3,890.45
| Facility | | $549.54 | $1,380.38 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | AS | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,772.37
| Facility | | $1,513.56 | $4,265.80 | $9,772.37 |