- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $4,570.88 / $11,481.54
| Facility | | $363.08 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,786.30 / $13,489.63
| Facility | | $1,862.09 | $4,786.30 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $524.81 / $1,445.44
| Facility | | $34.67 | $524.81 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $30.90 / $30.90 / $30.90
| Facility | AS | $30.90 | $30.90 | $30.90 |
- 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 |