- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.22 / $4,443.50 / $8,572.13
| Facility | | $1,074.22 | $4,443.50 | $8,572.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,196.00 / $11,433.00
| Facility | | $3,302.10 | $5,196.00 | $11,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $1,995.07 / $2,753.69
| Facility | | $1,184.00 | $1,995.07 | $2,753.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.70 / $95.70 / $95.70
| Facility | AS | $95.70 | $95.70 | $95.70 |
- 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 |