- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,466.84 / $11,748.98
| Facility | | $870.96 | $4,466.84 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $22,387.21
| Facility | | $3,548.13 | $10,471.29 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,454.71 / $6,918.31
| Facility | | $977.24 | $2,454.71 | $6,918.31 |
- 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
- $1,513.56 / $4,786.30 / $11,220.18
| Facility | | $1,513.56 | $4,786.30 | $11,220.18 |