- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.38 / $3,684.12 / $8,074.63
| Facility | | $1,419.38 | $3,684.12 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,629.58 / $1,629.58 / $2,279.87
| Facility | | $1,629.58 | $1,629.58 | $2,279.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $161.66 / $161.66 / $161.66
| Facility | AS | $161.66 | $161.66 | $161.66 |
- 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 |