- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,826.15 / $3,821.35 / $7,879.32
| Facility | | $1,826.15 | $3,821.35 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,754.10 / $16,184.00 / $29,541.81
| Facility | | $7,754.10 | $16,184.00 | $29,541.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,219.06
| Facility | | $895.00 | $950.00 | $2,219.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.70 / $218.70 / $218.70
| Facility | AS | $218.70 | $218.70 | $218.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.50 / $2,958.50 / $6,443.50
| Facility | | $1,278.50 | $2,958.50 | $6,443.50 |