- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,715.35 / $9,549.93
| Facility | | $977.24 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,495.41 / $12,022.64
| Facility | | $2,238.72 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,659.59 / $4,786.30
| Facility | | $323.59 | $1,659.59 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $6,918.31 / $15,488.17
| Facility | | $1,995.26 | $6,918.31 | $15,488.17 |