- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,897.79 / $8,511.38
| Facility | | $1,698.24 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $54.95 / $1,288.25
| Facility | | $19.05 | $54.95 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $3.80 / $7.08 / $7.08
| Facility | AS | $3.80 | $7.08 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $1,778.28
| Facility | | $338.84 | $707.95 | $1,778.28 |