- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $2,818.38 / $8,511.38
| Facility | | $204.17 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,715.19 / $15,135.61
| Facility | | $8,912.51 | $10,715.19 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $269.15 / $316.23
| Facility | | $186.21 | $269.15 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $363.08 / $363.08
| Facility | | $34.67 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $36.31 / $36.31 / $36.31
| Facility | AS | $36.31 | $36.31 | $36.31 |
- 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 |