- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,168.69 / $11,748.98
| Facility | | $954.99 | $4,168.69 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $20,417.38
| Facility | | $3,162.28 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,238.72 / $6,309.57
| Facility | | $1,230.27 | $2,238.72 | $6,309.57 |
- 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
- $2,454.71 / $7,244.36 / $16,982.44
| Facility | | $2,454.71 | $7,244.36 | $16,982.44 |