- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.64 / $3,463.50 / $7,720.19
| Facility | | $863.64 | $3,463.50 | $7,720.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,341.40 / $4,608.26 / $8,125.19
| Facility | | $2,341.40 | $4,608.26 | $8,125.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.47 / $788.47 / $994.78
| Facility | | $788.47 | $788.47 | $994.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.17 / $70.17 / $70.17
| Facility | AS | $70.17 | $70.17 | $70.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,577.00 / $2,665.00 / $5,510.00
| Facility | | $1,577.00 | $2,665.00 | $5,510.00 |