- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $4,570.88 / $11,220.18
| Facility | | $331.13 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,786.30 / $13,489.63
| Facility | | $2,344.23 | $4,786.30 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $537.03 / $1,445.44
| Facility | | $213.80 | $537.03 | $1,445.44 |
- 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
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |