- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $5,495.41 / $13,803.84
| Facility | | $794.33 | $5,495.41 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,128.61 / $12,022.64
| Facility | | $2,511.89 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $707.95 / $3,388.44
| Facility | | $34.67 | $707.95 | $3,388.44 |
- 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 / $6,760.83 / $16,218.10
| Facility | | $1,778.28 | $6,760.83 | $16,218.10 |