- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,466.84 / $10,964.78
| Facility | | $954.99 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,120.11 / $20,892.96
| Facility | | $3,630.78 | $9,120.11 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,905.46 / $5,495.41
| Facility | | $323.59 | $1,905.46 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | AS | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $23,988.33
| Facility | | $3,630.78 | $10,232.93 | $23,988.33 |