- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,251.00 / $4,055.50 / $9,734.55
| Facility | | $1,251.00 | $4,055.50 | $9,734.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $9,098.00 / $16,411.00
| Facility | | $4,977.00 | $9,098.00 | $16,411.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.79 / $2,000.36 / $9,479.35
| Facility | | $1,197.79 | $2,000.36 | $9,479.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.97 / $118.97 / $118.97
| Facility | AS | $118.97 | $118.97 | $118.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |