- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,890.45 / $14,125.38
| Facility | | $398.11 | $3,890.45 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $22,908.68 / $31,622.78
| Facility | | $4,365.16 | $22,908.68 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $338.84 / $389.05
| Facility | | $331.13 | $338.84 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $707.95
| Facility | | $338.84 | $524.81 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Facility | AS | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $9,549.93 / $16,218.10
| Facility | | $4,265.80 | $9,549.93 | $16,218.10 |