- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,786.30 / $11,748.98
| Facility | | $758.58 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,585.78 / $16,218.10
| Facility | | $2,818.38 | $7,585.78 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,148.15 / $4,265.80
| Facility | | $575.44 | $1,148.15 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | AS | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,456.54 / $15,848.93
| Facility | | $1,778.28 | $6,456.54 | $15,848.93 |