- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,162.28 / $13,803.84
| Facility | | $323.59 | $3,162.28 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,495.41 / $12,302.69
| Facility | | $3,388.44 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $371.54
| Facility | | $223.87 | $316.23 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $4,168.69
| Facility | | $323.59 | $426.58 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $42.66 / $42.66 / $42.66
| Facility | AS | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $602.56 / $3,162.28
| Facility | | $50.12 | $602.56 | $3,162.28 |