- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,467.37 / $6,165.95
| Facility | | $851.14 | $3,467.37 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,258.93 / $26,302.68
| Facility | | $691.83 | $1,258.93 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $2,454.71 / $2,454.71
| Facility | AS | $190.55 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,165.95
| Facility | | $2,454.71 | $3,715.35 | $6,165.95 |