- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,311.31 / $10,471.29
| Facility | | $501.19 | $3,311.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,165.95 / $13,489.63
| Facility | | $3,090.30 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $524.81 / $11,481.54
| Facility | | $218.78 | $524.81 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Facility | AS | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $1,047.13 / $3,548.13
| Facility | | $154.88 | $1,047.13 | $3,548.13 |