- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,467.37 / $9,549.93
| Facility | | $776.25 | $3,467.37 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,964.78
| Facility | | $2,089.30 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,659.59 / $3,981.07
| Facility | | $933.25 | $1,659.59 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Facility | AS | $95.50 | $95.50 | $95.50 |
- 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 |