- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.42 / $3,650.50 / $8,074.63
| Facility | | $1,426.42 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.21 / $8,766.98 / $14,405.53
| Facility | | $4,636.21 | $8,766.98 | $14,405.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.32 / $1,448.32 / $3,837.09
| Facility | | $1,448.32 | $1,448.32 | $3,837.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.33 / $140.33 / $140.33
| Facility | AS | $140.33 | $140.33 | $140.33 |
- 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 |