- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $4,677.35 / $10,715.19
| Facility | | $630.96 | $4,677.35 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,584.89 / $1,862.09
| Facility | | $616.60 | $1,584.89 | $1,862.09 |
- 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
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $12,022.64
| Facility | | $2,630.27 | $7,585.78 | $12,022.64 |