- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,630.27 / $11,748.98
| Facility | | $812.83 | $2,630.27 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,762.47 / $12,589.25
| Facility | | $5,011.87 | $7,762.47 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $3,019.95 / $8,128.31
| Facility | | $416.87 | $3,019.95 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Facility | AS | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,317.64
| Facility | | $1,230.27 | $4,265.80 | $8,317.64 |