- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,225.33 / $4,168.00 / $8,074.63
| Facility | | $2,225.33 | $4,168.00 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,329.50 / $16,401.00 / $29,216.95
| Facility | | $8,329.50 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,729.63 / $2,729.63 / $3,813.63
| Facility | | $2,729.63 | $2,729.63 | $3,813.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $270.41 / $270.41 / $270.41
| Facility | AS | $270.41 | $270.41 | $270.41 |
- 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 |