- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $4,677.35 / $11,481.54
| Facility | | $288.40 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,248.07 / $13,803.84
| Facility | | $2,570.40 | $5,248.07 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $489.78 / $1,348.96
| Facility | | $141.25 | $489.78 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $29.51 / $29.51 / $29.51
| Facility | AS | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |