- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,466.84 / $10,964.78
| Facility | | $776.25 | $4,466.84 | $10,964.78 |
- 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
- $257.04 / $676.08 / $2,089.30
| Facility | | $257.04 | $676.08 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $42.66 / $42.66 / $42.66
| Facility | AS | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,218.10
| Facility | | $2,454.71 | $7,244.36 | $16,218.10 |