- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,311.31 / $12,022.64
| Facility | | $489.78 | $3,311.31 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $11,220.18
| Facility | | $2,238.72 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $602.56 / $1,659.59
| Facility | | $34.67 | $602.56 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Facility | AS | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,202.26 / $3,630.78
| Facility | | $288.40 | $1,202.26 | $3,630.78 |