- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.96 / $3,772.57 / $8,988.50
| Facility | | $1,175.96 | $3,772.57 | $8,988.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,496.00 / $26,922.00 / $68,628.00
| Facility | | $9,496.00 | $26,922.00 | $68,628.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.14 / $1,176.14 / $3,183.38
| Facility | | $1,176.14 | $1,176.14 | $3,183.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.83 / $114.83 / $114.83
| Facility | AS | $114.83 | $114.83 | $114.83 |
- 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 |