- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,248.07 / $14,125.38
| Facility | | $812.83 | $5,248.07 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $16,595.87 / $53,703.18
| Facility | | $8,317.64 | $16,595.87 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Facility | AS | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $27,542.29 / $58,884.37
| Facility | | $11,220.18 | $27,542.29 | $58,884.37 |