- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.73 / $3,494.50 / $7,995.57
| Facility | | $1,144.73 | $3,494.50 | $7,995.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,892.92 / $8,593.09 / $13,917.11
| Facility | | $3,892.92 | $8,593.09 | $13,917.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,309.66
| Facility | | $680.00 | $870.49 | $1,309.66 |
- 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
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |