- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,818.38 / $8,511.38
| Facility | | $275.42 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $181.97 / $724.44
| Facility | | $67.61 | $181.97 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $18.20 / $18.20 / $18.20
| Facility | AS | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,122.02 / $3,467.37
| Facility | | $281.84 | $1,122.02 | $3,467.37 |