- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,951.21 / $8,709.64
| Facility | | $794.33 | $2,951.21 | $8,709.64 |
- 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
- $758.58 / $1,659.59 / $6,025.60
| Facility | | $758.58 | $1,659.59 | $6,025.60 |
- 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
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |