- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.45 / $3,244.78 / $7,920.26
| Facility | | $967.45 | $3,244.78 | $7,920.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,913.08 / $8,269.50 / $13,211.02
| Facility | | $3,913.08 | $8,269.50 | $13,211.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.82 / $1,024.82 / $1,436.49
| Facility | | $1,024.82 | $1,024.82 | $1,436.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.85 / $101.85 / $101.85
| Facility | AS | $101.85 | $101.85 | $101.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |