- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $4,073.80 / $10,964.78
| Facility | | $741.31 | $4,073.80 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $8,709.64 / $20,417.38
| Facility | | $3,890.45 | $8,709.64 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,238.72 / $10,964.78
| Facility | | $630.96 | $2,238.72 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Facility | AS | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,709.64 / $19,054.61
| Facility | | $2,951.21 | $8,709.64 | $19,054.61 |