- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,916.96 / $3,879.50 / $8,074.63
| Facility | | $1,916.96 | $3,879.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,754.10 / $16,184.00 / $28,048.48
| Facility | | $7,754.10 | $16,184.00 | $28,048.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.50 / $2,375.41 / $4,890.73
| Facility | | $2,278.50 | $2,375.41 | $4,890.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $235.29 / $235.29 / $235.29
| Facility | AS | $235.29 | $235.29 | $235.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,269.00 / $7,384.00
| Facility | | $1,185.00 | $3,269.00 | $7,384.00 |