- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $2,818.38 / $8,511.38
| Facility | | $181.97 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,715.19 / $11,220.18
| Facility | | $5,888.44 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $275.42
| Facility | | $162.18 | $234.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $316.23 / $316.23
| Facility | | $34.67 | $316.23 | $316.23 |
- 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
- $602.56 / $4,466.84 / $30,199.52
| Facility | | $602.56 | $4,466.84 | $30,199.52 |