- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $1,778.28 / $7,943.28
| Facility | | $77.62 | $1,778.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,715.19 / $11,220.18
| Facility | | $9,549.93 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $87.10 / $112.20
| Facility | | $60.26 | $87.10 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $117.49 / $117.49
| Facility | | $34.67 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $11.75 / $11.75 / $11.75
| Facility | AS | $11.75 | $11.75 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $602.56 / $3,162.28
| Facility | | $50.12 | $602.56 | $3,162.28 |