- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,890.45 / $7,943.28
| Facility | | $2,041.74 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,187.76 / $3,981.07
| Facility | | $831.76 | $2,187.76 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $173.78 / $1,949.84
| Facility | | $131.83 | $173.78 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $33.88 / $33.88 / $63.10
| Facility | AS | $33.88 | $33.88 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $2,089.30 / $5,248.07
| Facility | | $173.78 | $2,089.30 | $5,248.07 |