- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,981.07 / $9,549.93
| Facility | | $707.95 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $912.01 / $1,659.59
| Facility | | $436.52 | $912.01 | $1,659.59 |
- 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
- $3,235.94 / $5,888.44 / $11,481.54
| Facility | | $3,235.94 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,623.41 / $9,772.37
| Facility | | $1,698.24 | $5,623.41 | $9,772.37 |