- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,691.53 / $10,232.93
| Facility | | $1,905.46 | $2,691.53 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $147.91 / $407.38
| Facility | | $109.65 | $147.91 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $26,302.68 / $26,302.68
| Facility | | $54.95 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | AS | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $2,511.89
| Facility | | $295.12 | $812.83 | $2,511.89 |