- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,115.73 / $3,827.50 / $7,887.17
| Facility | | $2,115.73 | $3,827.50 | $7,887.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $16,401.00 / $29,866.68
| Facility | | $8,512.20 | $16,401.00 | $29,866.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,606.76
| Facility | | $895.00 | $950.00 | $2,606.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.88 / $257.88 / $257.88
| Facility | AS | $257.88 | $257.88 | $257.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.50 / $2,975.46 / $6,443.50
| Facility | | $1,278.50 | $2,975.46 | $6,443.50 |