- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,311.31 / $11,220.18
| Facility | | $812.83 | $3,311.31 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,128.61 / $20,892.96
| Facility | | $1,737.80 | $5,128.61 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,862.09 / $23,988.33
| Facility | | $707.95 | $1,862.09 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | AS | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,888.44 / $14,454.40
| Facility | | $1,995.26 | $5,888.44 | $14,454.40 |