- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,890.45 / $11,481.54
| Facility | | $776.25 | $3,890.45 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,079.46 / $29,512.09
| Facility | | $2,570.40 | $7,079.46 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,174.90 / $14,791.08
| Facility | | $630.96 | $1,174.90 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.07 / $66.07 / $66.07
| Facility | AS | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $16,982.44 / $42,657.95
| Facility | | $4,897.79 | $16,982.44 | $42,657.95 |