- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,466.84 / $11,220.18
| Facility | | $870.96 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $17,378.01
| Facility | | $3,311.31 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $977.24 / $3,019.95
| Facility | | $371.54 | $977.24 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | AS | $64.57 | $64.57 | $64.57 |
- 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 |