- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.64 / $3,650.50 / $8,074.63
| Facility | | $1,366.64 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.21 / $8,766.98 / $14,467.75
| Facility | | $4,636.21 | $8,766.98 | $14,467.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,381.32 / $1,381.32 / $3,655.79
| Facility | | $1,381.32 | $1,381.32 | $3,655.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.77 / $133.77 / $133.77
| Facility | AS | $133.77 | $133.77 | $133.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $3,236.00 / $7,168.00
| Facility | | $1,367.00 | $3,236.00 | $7,168.00 |