- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,514.53 / $3,683.18 / $8,074.63
| Facility | | $1,514.53 | $3,683.18 | $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
- $1,536.61 / $1,536.61 / $4,066.61
| Facility | | $1,536.61 | $1,536.61 | $4,066.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $148.79 / $148.79 / $148.79
| Facility | AS | $148.79 | $148.79 | $148.79 |
- 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 |