- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,599.41 / $3,719.40 / $8,016.63
| Facility | | $1,599.41 | $3,719.40 | $8,016.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.10 / $8,883.46 / $15,216.00
| Facility | | $4,769.10 | $8,883.46 | $15,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.92 / $1,623.92 / $4,296.14
| Facility | | $1,623.92 | $1,623.92 | $4,296.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $157.26 / $157.26 / $157.26
| Facility | AS | $157.26 | $157.26 | $157.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,152.00
| Facility | | $1,292.00 | $3,325.00 | $8,152.00 |