- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.25 / $4,182.00 / $7,133.00
| Facility | | $1,195.25 | $4,182.00 | $7,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,827.50 / $7,103.60 / $11,253.10
| Facility | | $1,827.50 | $7,103.60 | $11,253.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.78 / $1,314.73 / $9,437.00
| Facility | | $967.78 | $1,314.73 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.20 / $258.20 / $5,155.43
| Facility | AS | $258.20 | $258.20 | $5,155.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,899.00 / $13,500.00
| Facility | | $5,279.00 | $7,899.00 | $13,500.00 |