- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.31 / $4,188.50 / $9,185.50
| Facility | | $1,052.31 | $4,188.50 | $9,185.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,881.00 / $14,586.00
| Facility | | $3,302.10 | $5,881.00 | $14,586.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.12 / $1,814.17 / $2,552.35
| Facility | | $1,170.12 | $1,814.17 | $2,552.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.12 / $92.12 / $92.12
| Facility | AS | $92.12 | $92.12 | $92.12 |
- 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 |