- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,626.00 / $3,695.07 / $7,975.63
| Facility | | $1,626.00 | $3,695.07 | $7,975.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,785.50 / $12,249.00 / $23,008.27
| Facility | | $5,785.50 | $12,249.00 | $23,008.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,874.50 / $1,874.50 / $2,583.26
| Facility | | $1,874.50 | $1,874.50 | $2,583.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $183.17 / $183.17 / $183.17
| Facility | AS | $183.17 | $183.17 | $183.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $10,133.00 / $19,962.00
| Facility | | $4,873.00 | $10,133.00 | $19,962.00 |