- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,288.25 / $3,235.94
| Facility | | $467.74 | $1,288.25 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $6,456.54
| Facility | | $109.65 | $151.36 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,748.98 / $11,748.98
| Facility | | $5,011.87 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | AS | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,317.64 / $21,379.62
| Facility | | $4,365.16 | $8,317.64 | $21,379.62 |