- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,218.29 / $3,650.50 / $8,373.50
| Facility | | $1,218.29 | $3,650.50 | $8,373.50 |
- 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
- $1,207.86 / $1,207.86 / $3,202.55
| Facility | | $1,207.86 | $1,207.86 | $3,202.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $117.07 / $117.07 / $117.07
| Facility | AS | $117.07 | $117.07 | $117.07 |
- 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 |