- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,786.30 / $16,595.87
| Facility | | $831.76 | $4,786.30 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,165.95 / $13,803.84
| Facility | | $2,818.38 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,659.59 / $4,570.88
| Facility | | $323.59 | $1,659.59 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $93.33 / $93.33 / $93.33
| Facility | AS | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |