- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,467.37 / $12,022.64
| Facility | | $575.44 | $3,467.37 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,011.87 / $14,454.40
| Facility | | $1,621.81 | $5,011.87 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $32,359.37 / $57,543.99
| Facility | | $257.04 | $32,359.37 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $25.70 / $25.70 / $25.70
| Facility | AS | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |