- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.12 / $3,683.00 / $8,373.50
| Facility | | $1,059.12 | $3,683.00 | $8,373.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,233.00 / $7,608.00 / $10,043.00
| Facility | | $3,233.00 | $7,608.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,034.98 / $1,034.98 / $1,413.35
| Facility | | $1,034.98 | $1,034.98 | $1,413.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.21 / $100.21 / $100.21
| Facility | AS | $100.21 | $100.21 | $100.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.00 / $1,221.00 / $2,883.00
| Facility | | $444.00 | $1,221.00 | $2,883.00 |