- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,019.95 / $10,232.93
| Facility | | $794.33 | $3,019.95 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,413.10 / $30,199.52
| Facility | | $3,630.78 | $7,413.10 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,398.83 / $8,511.38
| Facility | | $602.56 | $2,398.83 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | AS | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,709.64 / $19,054.61
| Facility | | $2,951.21 | $8,709.64 | $19,054.61 |