- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,630.78 / $9,549.93
| Facility | | $977.24 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $11,220.18
| Facility | | $2,089.30 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,412.54 / $3,235.94
| Facility | | $602.56 | $1,412.54 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Facility | AS | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,011.87 / $11,748.98
| Facility | | $1,348.96 | $5,011.87 | $11,748.98 |