- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,454.71 / $7,585.78
| Facility | | $851.14 | $2,454.71 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $17,782.79 / $28,840.32
| Facility | | $11,220.18 | $17,782.79 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $6,456.54 / $24,547.09
| Facility | | $870.96 | $6,456.54 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | AS | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $16,218.10 / $25,703.96
| Facility | | $5,495.41 | $16,218.10 | $25,703.96 |