- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,786.30 / $11,748.98
| Facility | | $794.33 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,760.83 / $16,218.10
| Facility | | $2,951.21 | $6,760.83 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $5,248.07
| Facility | | $316.23 | $524.81 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Facility | AS | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,884.03 / $9,772.37
| Facility | | $524.81 | $2,884.03 | $9,772.37 |