- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,897.79 / $12,022.64
| Facility | | $977.24 | $4,897.79 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,481.54 / $25,703.96
| Facility | | $4,168.69 | $11,481.54 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,041.74 / $5,011.87
| Facility | | $588.84 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Facility | AS | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,982.44
| Facility | | $2,511.89 | $7,244.36 | $16,982.44 |