- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,702.35 / $4,668.50 / $9,767.50
| Facility | | $1,702.35 | $4,668.50 | $9,767.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,128.50 / $12,374.50 / $39,007.80
| Facility | | $4,128.50 | $12,374.50 | $39,007.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.50 / $950.00 / $1,724.24
| Facility | | $887.50 | $950.00 | $1,724.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.46 / $171.46 / $171.46
| Facility | AS | $171.46 | $171.46 | $171.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |