- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,365.16 / $10,715.19
| Facility | | $812.83 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,511.38 / $17,378.01
| Facility | | $3,388.44 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $891.25 / $2,454.71
| Facility | | $323.59 | $891.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Facility | AS | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,585.78 / $17,782.79
| Facility | | $2,454.71 | $7,585.78 | $17,782.79 |