- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,314.50 / $4,433.00 / $8,074.63
| Facility | | $2,314.50 | $4,433.00 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,458.00 / $17,400.00
| Facility | | $5,470.00 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,785.27 / $2,785.27 / $5,526.55
| Facility | | $2,785.27 | $2,785.27 | $5,526.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $271.23 / $271.23 / $271.23
| Facility | AS | $271.23 | $271.23 | $271.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |