- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,570.88 / $10,964.78
| Facility | | $676.08 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $22,387.21
| Facility | | $3,548.13 | $10,471.29 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $912.01 / $3,467.37
| Facility | | $467.74 | $912.01 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Facility | AS | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $14,125.38
| Facility | | $1,949.84 | $5,754.40 | $14,125.38 |