- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.15 / $3,650.50 / $8,074.63
| Facility | | $1,317.15 | $3,650.50 | $8,074.63 |
- 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
- $1,325.21 / $1,325.21 / $3,513.73
| Facility | | $1,325.21 | $1,325.21 | $3,513.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.44 / $128.44 / $128.44
| Facility | AS | $128.44 | $128.44 | $128.44 |
- 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 |