- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,818.38 / $8,912.51
| Facility | | $323.59 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,677.35 / $12,022.64
| Facility | | $2,511.89 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $537.03 / $46,773.51
| Facility | | $281.84 | $537.03 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $28.18 / $28.18 / $28.18
| Facility | AS | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,623.41 / $12,302.69
| Facility | | $1,819.70 | $5,623.41 | $12,302.69 |