- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.33 / $3,166.00 / $7,632.44
| Facility | | $1,091.33 | $3,166.00 | $7,632.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,050.00 / $8,240.00
| Facility | | $2,114.00 | $4,050.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.36 / $1,533.10 / $2,782.32
| Facility | | $902.36 | $1,533.10 | $2,782.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.27 / $92.27 / $92.27
| Facility | AS | $92.27 | $92.27 | $92.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.50 / $4,276.00 / $8,976.50
| Facility | | $1,454.50 | $4,276.00 | $8,976.50 |