- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,528.84 / $4,824.14 / $10,506.16
| Facility | | $1,528.84 | $4,824.14 | $10,506.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,443.89 / $11,982.00 / $22,770.10
| Facility | | $6,443.89 | $11,982.00 | $22,770.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $3,585.57 / $9,783.84
| Facility | | $2,321.00 | $3,585.57 | $9,783.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.51 / $133.51 / $133.51
| Facility | AS | $133.51 | $133.51 | $133.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,500.00 / $8,198.00
| Facility | | $1,292.00 | $3,500.00 | $8,198.00 |