- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $10,471.29
| Facility | | $794.33 | $3,311.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,918.31 / $20,417.38
| Facility | | $2,511.89 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,905.46 / $8,912.51
| Facility | | $812.83 | $1,905.46 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | AS | $112.20 | $112.20 | $112.20 |
- 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 |