- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,630.27 / $8,511.38
| Facility | | $794.33 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,398.83 / $4,365.16
| Facility | | $1,479.11 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $831.76 / $1,122.02
| Facility | | $645.65 | $831.76 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,202.26 / $1,659.59
| Facility | | $794.33 | $1,202.26 | $1,659.59 |
- 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
- $977.24 / $5,011.87 / $12,302.69
| Facility | | $977.24 | $5,011.87 | $12,302.69 |