- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,479.11 / $4,365.16
| Facility | | $776.25 | $1,479.11 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $6,918.31
| Facility | | $2,238.72 | $4,570.88 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,698.24 / $1,698.24
| Facility | | $588.84 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,047.13 / $2,041.74
| Facility | | $524.81 | $1,047.13 | $2,041.74 |
- 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
- $831.76 / $2,398.83 / $6,309.57
| Facility | | $831.76 | $2,398.83 | $6,309.57 |