- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,818.38 / $9,772.37
| Facility | | $707.95 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,754.40 / $16,218.10
| Facility | | $2,754.23 | $5,754.40 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $870.96
| Facility | | $501.19 | $616.60 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $2,290.87
| Facility | | $977.24 | $977.24 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | AS | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $8,511.38
| Facility | | $630.96 | $1,862.09 | $8,511.38 |