- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.27 / $3,650.50 / $8,074.63
| Facility | | $1,141.27 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,752.50 / $22,245.55
| Facility | | $5,195.00 | $10,752.50 | $22,245.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.98 / $1,271.98 / $1,757.75
| Facility | | $1,271.98 | $1,271.98 | $1,757.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.63 / $124.63 / $124.63
| Facility | AS | $124.63 | $124.63 | $124.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |