- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,183.76 / $5,522.50 / $13,209.82
| Facility | | $1,183.76 | $5,522.50 | $13,209.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,583.00 / $9,198.00 / $17,951.00
| Facility | | $4,583.00 | $9,198.00 | $17,951.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,108.48 / $3,400.69 / $4,327.06
| Facility | | $3,108.48 | $3,400.69 | $4,327.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.00 / $102.00 / $102.00
| Facility | AS | $102.00 | $102.00 | $102.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |