- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,570.88 / $11,220.18
| Facility | | $933.25 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,317.64 / $15,488.17
| Facility | | $3,162.28 | $8,317.64 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,698.24 / $4,168.69
| Facility | | $912.01 | $1,698.24 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | AS | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |