- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.57 / $3,460.04 / $7,975.63
| Facility | | $1,074.57 | $3,460.04 | $7,975.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,085.00 / $11,898.00 / $22,154.73
| Facility | | $6,085.00 | $11,898.00 | $22,154.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.98 / $1,078.98 / $1,491.69
| Facility | | $1,078.98 | $1,078.98 | $1,491.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $105.77 / $105.77 / $105.77
| Facility | AS | $105.77 | $105.77 | $105.77 |
- 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 |