- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,715.35 / $7,943.28
| Facility | | $1,862.09 | $3,715.35 | $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
- $77.62 / $104.71 / $1,230.27
| Facility | | $77.62 | $104.71 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.42 / $20.42 / $38.02
| Facility | AS | $20.42 | $20.42 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,122.02 / $2,187.76
| Facility | | $281.84 | $1,122.02 | $2,187.76 |