- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,786.30 / $11,481.54
| Facility | | $977.24 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,025.60 / $13,803.84
| Facility | | $2,630.27 | $6,025.60 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,348.96 / $3,548.13
| Facility | | $323.59 | $1,348.96 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | AS | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $6,918.31 / $15,488.17
| Facility | | $1,995.26 | $6,918.31 | $15,488.17 |