- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $9,332.54
| Facility | | $891.25 | $3,311.31 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $7,079.46 / $14,791.08
| Facility | | $1,905.46 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,412.54 / $3,548.13
| Facility | | $524.81 | $1,412.54 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | AS | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,549.93
| Facility | | $1,047.13 | $3,981.07 | $9,549.93 |