- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $2,691.53 / $4,365.16
| Facility | | $138.04 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $2,630.27 / $4,786.30
| Facility | | $0.02 | $2,630.27 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $74.13 / $74.13
| Facility | | $39.81 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $676.08 / $1,202.26
| Facility | | $141.25 | $676.08 | $1,202.26 |
- 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
- $177.83 / $501.19 / $1,230.27
| Facility | | $177.83 | $501.19 | $1,230.27 |