- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,162.28 / $9,549.93
| Facility | | $489.78 | $3,162.28 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,677.35 / $12,022.64
| Facility | | $2,511.89 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $575.44 / $46,773.51
| Facility | | $309.03 | $575.44 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $30.90 / $30.90 / $30.90
| Facility | AS | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,623.41 / $12,302.69
| Facility | | $1,819.70 | $5,623.41 | $12,302.69 |