- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $4,466.84 / $11,481.54
| Facility | | $128.82 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,897.79 / $12,882.50
| Facility | | $2,570.40 | $4,897.79 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $229.09 / $741.31
| Facility | | $91.20 | $229.09 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $14.13 / $14.13 / $14.13
| Facility | AS | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $1,047.13 / $3,467.37
| Facility | | $154.88 | $1,047.13 | $3,467.37 |