- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $524.81 / $8,709.64
| Facility | | $213.80 | $524.81 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $281.84 / $426.58
| Facility | | $213.80 | $281.84 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,318.26 / $1,318.26
| Facility | | $56.23 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | AS | $131.83 | $131.83 | $131.83 |