- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.30 / $13,631.65 / $22,078.72
| Facility | | $902.30 | $13,631.65 | $22,078.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.91 / $1,034.17 / $1,126.75
| Facility | | $924.91 | $1,034.17 | $1,126.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.46 / $996.46 / $996.46
| Facility | | $996.46 | $996.46 | $996.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.83 / $97.83 / $97.83
| Facility | AS | $97.83 | $97.83 | $97.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,302.56 / $9,822.28 / $17,665.09
| Facility | | $9,302.56 | $9,822.28 | $17,665.09 |