- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,365.16 / $11,481.54
| Facility | | $870.96 | $4,365.16 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $20,417.38
| Facility | | $3,162.28 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,698.24 / $5,011.87
| Facility | | $794.33 | $1,698.24 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | AS | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |