- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.39 / $3,650.50 / $8,074.63
| Facility | | $1,373.39 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $7,363.00 / $12,538.00
| Facility | | $4,452.00 | $7,363.00 | $12,538.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,399.51 / $1,399.51 / $3,708.85
| Facility | | $1,399.51 | $1,399.51 | $3,708.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $135.63 / $135.63 / $135.63
| Facility | AS | $135.63 | $135.63 | $135.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |