- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,090.30 / $9,120.11
| Facility | | $891.25 | $3,090.30 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,754.40 / $13,489.63
| Facility | | $1,819.70 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,698.24 / $5,495.41
| Facility | | $831.76 | $1,698.24 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- 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 |