- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.37 / $4,443.50 / $9,450.50
| Facility | | $1,586.37 | $4,443.50 | $9,450.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,749.00 / $9,644.00 / $17,206.00
| Facility | | $4,749.00 | $9,644.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.27 / $2,862.32 / $5,341.07
| Facility | | $1,454.27 | $2,862.32 | $5,341.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.51 / $144.51 / $144.51
| Facility | AS | $144.51 | $144.51 | $144.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |