- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,495.41 / $10,964.78
| Facility | | $1,047.13 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $323.59 / $501.19
| Facility | | $141.25 | $323.59 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $14.13 / $14.13 / $14.13
| Facility | AS | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $1,348.96
| Facility | | $537.03 | $724.44 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,548.82 / $3,890.45
| Facility | | $269.15 | $1,548.82 | $3,890.45 |