- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,452.19 / $3,606.50 / $8,074.63
| Facility | | $1,452.19 | $3,606.50 | $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
- $1,491.29 / $1,491.29 / $3,944.72
| Facility | | $1,491.29 | $1,491.29 | $3,944.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.38 / $144.38 / $144.38
| Facility | AS | $144.38 | $144.38 | $144.38 |
- 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 |