- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.19 / $3,172.97 / $7,517.50
| Facility | | $1,007.19 | $3,172.97 | $7,517.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $10,517.23
| Facility | | $3,248.00 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.58 / $1,574.05 / $2,070.38
| Facility | | $1,427.58 | $1,574.05 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.76 / $142.76 / $142.76
| Facility | AS | $142.76 | $142.76 | $142.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.00 / $3,764.00 / $7,934.00
| Facility | | $1,832.00 | $3,764.00 | $7,934.00 |