- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.40 / $4,388.50 / $10,174.95
| Facility | | $1,166.40 | $4,388.50 | $10,174.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $9,098.00 / $19,050.00
| Facility | | $4,977.00 | $9,098.00 | $19,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.40 / $2,000.36 / $8,928.98
| Facility | | $953.40 | $2,000.36 | $8,928.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.58 / $94.58 / $94.58
| Facility | AS | $94.58 | $94.58 | $94.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,144.50 / $8,764.50 / $15,993.50
| Facility | | $4,144.50 | $8,764.50 | $15,993.50 |