- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.93 / $3,694.57 / $8,373.50
| Facility | | $1,394.93 | $3,694.57 | $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
- $1,445.75 / $1,445.75 / $3,861.01
| Facility | | $1,445.75 | $1,445.75 | $3,861.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.59 / $140.59 / $140.59
| Facility | AS | $140.59 | $140.59 | $140.59 |
- 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 |