- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $4,466.84 / $12,022.64
| Facility | | $380.19 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,317.64 / $16,218.10
| Facility | | $3,019.95 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $741.31 / $2,041.74
| Facility | | $323.59 | $741.31 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | AS | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $15,135.61 / $38,904.51
| Facility | | $4,897.79 | $15,135.61 | $38,904.51 |