- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,235.94 / $9,549.93
| Facility | | $630.96 | $3,235.94 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $9,332.54 / $16,218.10
| Facility | | $3,801.89 | $9,332.54 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $758.58 / $2,089.30
| Facility | | $34.67 | $758.58 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $45.71 / $45.71 / $45.71
| Facility | AS | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,715.35
| Facility | | $295.12 | $1,202.26 | $3,715.35 |