- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.25 / $4,597.00 / $9,450.50
| Facility | | $1,257.25 | $4,597.00 | $9,450.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,879.72 / $8,490.10 / $13,628.92
| Facility | | $3,879.72 | $8,490.10 | $13,628.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.72 / $1,146.72 / $1,588.97
| Facility | | $1,146.72 | $1,146.72 | $1,588.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.67 / $112.67 / $112.67
| Facility | AS | $112.67 | $112.67 | $112.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |