- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $4,570.88 / $11,481.54
| Facility | | $316.23 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $11,481.54 / $26,302.68
| Facility | | $4,265.80 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $537.03 / $12,589.25
| Facility | | $199.53 | $537.03 | $12,589.25 |
- 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 |