- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,818.38 / $8,912.51
| Facility | | $371.54 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,786.30 / $13,803.84
| Facility | | $2,570.40 | $4,786.30 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $602.56 / $1,819.70
| Facility | | $223.87 | $602.56 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | AS | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |