- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,495.41 / $11,481.54
| Facility | | $1,047.13 | $5,495.41 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $323.59 / $1,548.82
| Facility | | $34.67 | $323.59 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,630.27 / $6,309.57
| Facility | | $1,348.96 | $2,630.27 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,737.80 / $4,168.69
| Facility | | $331.13 | $1,737.80 | $4,168.69 |