- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,090.30 / $8,317.64
| Facility | | $575.44 | $3,090.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,348.96 / $1,995.26
| Facility | | $416.87 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $112.20 / $1,949.84
| Facility | | $63.10 | $112.20 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $16.98 / $16.98 / $31.62
| Facility | AS | $16.98 | $16.98 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,412.54 / $2,187.76
| Facility | | $691.83 | $1,412.54 | $2,187.76 |