- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,698.24 / $4,365.16
| Facility | | $891.25 | $1,698.24 | $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
- $776.25 / $3,090.30 / $3,090.30
| Facility | | $776.25 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,905.46 / $2,398.83
| Facility | | $524.81 | $1,905.46 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,090.30 / $8,128.31
| Facility | | $891.25 | $3,090.30 | $8,128.31 |