- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,780.04 / $3,865.21 / $8,074.63
| Facility | | $1,780.04 | $3,865.21 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.21 / $8,766.98 / $15,216.00
| Facility | | $4,636.21 | $8,766.98 | $15,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,881.48 / $1,881.48 / $4,897.95
| Facility | | $1,881.48 | $1,881.48 | $4,897.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.09 / $182.09 / $182.09
| Facility | AS | $182.09 | $182.09 | $182.09 |
- 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 |