- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $3,162.28 / $10,964.78
| Facility | | $169.82 | $3,162.28 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,786.30 / $12,589.25
| Facility | | $2,570.40 | $4,786.30 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $181.97 / $549.54
| Facility | | $67.61 | $181.97 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $11.75 / $11.75 / $11.75
| Facility | AS | $11.75 | $11.75 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $3,630.78
| Facility | | $269.15 | $1,202.26 | $3,630.78 |