- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,786.30 / $13,803.84
| Facility | | $977.24 | $4,786.30 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $22,387.21
| Facility | | $3,162.28 | $8,511.38 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,041.74 / $10,964.78
| Facility | | $933.25 | $2,041.74 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Facility | AS | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,952.62
| Facility | | $3,019.95 | $8,709.64 | $19,952.62 |