- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,715.35 / $9,772.37
| Facility | | $691.83 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,791.08
| Facility | | $2,818.38 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,412.54 / $3,311.31
| Facility | | $676.08 | $1,412.54 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | AS | $77.62 | $77.62 | $77.62 |
- 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 |