- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $4,265.80 / $10,964.78
| Facility | | $446.68 | $4,265.80 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $13,803.84
| Facility | | $2,754.23 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $354.81 / $4,677.35
| Facility | | $173.78 | $354.81 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $17.38 / $17.38 / $17.38
| Facility | AS | $17.38 | $17.38 | $17.38 |
- 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 |