- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.48 / $5,074.00 / $9,850.50
| Facility | | $1,623.48 | $5,074.00 | $9,850.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,904.50 / $16,184.00 / $27,756.86
| Facility | | $6,904.50 | $16,184.00 | $27,756.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,484.26 / $1,484.26 / $2,073.76
| Facility | | $1,484.26 | $1,484.26 | $2,073.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.04 / $147.04 / $147.04
| Facility | AS | $147.04 | $147.04 | $147.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,887.50 / $7,130.00 / $14,142.61
| Facility | | $3,887.50 | $7,130.00 | $14,142.61 |