- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.95 / $3,706.14 / $9,649.90
| Facility | | $1,360.95 | $3,706.14 | $9,649.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,827.50 / $14,079.66 / $25,388.39
| Facility | | $7,827.50 | $14,079.66 | $25,388.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,756.32 / $5,267.46 / $9,852.00
| Facility | | $1,756.32 | $5,267.46 | $9,852.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.03 / $174.03 / $174.03
| Facility | AS | $174.03 | $174.03 | $174.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $12,027.00
| Facility | | $1,292.00 | $3,325.00 | $12,027.00 |