- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,570.88 / $12,022.64
| Facility | | $602.56 | $4,570.88 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $13,489.63 / $28,840.32
| Facility | | $4,570.88 | $13,489.63 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,047.13 / $12,589.25
| Facility | | $398.11 | $1,047.13 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | AS | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |