- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $8,511.38
| Facility | | $812.83 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,079.46 / $13,803.84
| Facility | | $2,238.72 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $309.03 / $5,754.40
| Facility | | $169.82 | $309.03 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.65 / $83.18 / $83.18
| Facility | AS | $43.65 | $83.18 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $9,549.93
| Facility | | $2,137.96 | $3,019.95 | $9,549.93 |