- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,073.80 / $10,715.19
| Facility | | $831.76 | $4,073.80 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $12,302.69
| Facility | | $2,454.71 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,621.81 / $3,715.35
| Facility | | $870.96 | $1,621.81 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Facility | AS | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,168.69 / $9,549.93
| Facility | | $1,479.11 | $4,168.69 | $9,549.93 |