- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,466.84 / $10,715.19
| Facility | | $776.25 | $4,466.84 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,165.95 / $12,302.69
| Facility | | $2,344.23 | $6,165.95 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,202.26 / $3,162.28
| Facility | | $602.56 | $1,202.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | AS | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $9,549.93
| Facility | | $1,348.96 | $4,073.80 | $9,549.93 |