- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,801.89 / $10,232.93
| Facility | | $954.99 | $3,801.89 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,370.32 / $11,220.18
| Facility | | $2,290.87 | $5,370.32 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,778.28 / $5,128.61
| Facility | | $323.59 | $1,778.28 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | AS | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,691.53 / $6,165.95
| Facility | | $707.95 | $2,691.53 | $6,165.95 |