- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $4,570.88 / $11,481.54
| Facility | | $181.97 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,606.93 / $13,803.84
| Facility | | $2,884.03 | $6,606.93 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $354.81 / $977.24
| Facility | | $186.21 | $354.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.42 / $20.42 / $20.42
| Facility | AS | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,818.38 / $9,772.37
| Facility | | $524.81 | $2,818.38 | $9,772.37 |