- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,897.79 / $13,182.57
| Facility | | $776.25 | $4,897.79 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $933.25
| Facility | | $34.67 | $398.11 | $933.25 |
- 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
- $4,365.16 / $8,317.64 / $16,595.87
| Facility | | $4,365.16 | $8,317.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $12,022.64
| Facility | | $2,630.27 | $7,585.78 | $12,022.64 |