- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.50 / $4,631.44 / $10,379.74
| Facility | | $1,018.50 | $4,631.44 | $10,379.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,881.00 / $13,523.26
| Facility | | $3,302.10 | $5,881.00 | $13,523.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.14 / $1,775.57 / $2,527.24
| Facility | | $898.14 | $1,775.57 | $2,527.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.59 / $67.59 / $67.59
| Facility | AS | $67.59 | $67.59 | $67.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,622.00
| Facility | | $2,200.00 | $5,111.00 | $9,622.00 |