- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $4,570.88 / $11,481.54
| Facility | | $288.40 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $13,489.63 / $28,840.32
| Facility | | $4,570.88 | $13,489.63 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $537.03 / $1,479.11
| Facility | | $34.67 | $537.03 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Facility | AS | $31.62 | $31.62 | $31.62 |
- 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 |