- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.72 / $3,069.44 / $7,879.32
| Facility | | $1,116.72 | $3,069.44 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,175.50 / $8,267.55 / $13,327.02
| Facility | | $4,175.50 | $8,267.55 | $13,327.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,271.82
| Facility | | $895.00 | $950.00 | $1,271.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.39 / $126.39 / $126.39
| Facility | AS | $126.39 | $126.39 | $126.39 |
- 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 |