- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,715.35 / $10,471.29
| Facility | | $977.24 | $3,715.35 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $13,803.84
| Facility | | $2,570.40 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,398.83 / $6,606.93
| Facility | | $645.65 | $2,398.83 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $17,378.01
| Facility | | $2,454.71 | $7,244.36 | $17,378.01 |