- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $5,128.61 / $13,803.84
| Facility | | $707.95 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $12,589.25 / $53,703.18
| Facility | | $1,584.89 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Facility | AS | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $12,302.69 / $18,620.87
| Facility | | $4,073.80 | $12,302.69 | $18,620.87 |