- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,370.32 / $12,882.50
| Facility | | $676.08 | $5,370.32 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,964.78 / $22,387.21
| Facility | | $3,548.13 | $10,964.78 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,089.30 / $9,549.93
| Facility | | $645.65 | $2,089.30 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | AS | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,606.93 / $15,848.93
| Facility | | $1,778.28 | $6,606.93 | $15,848.93 |