- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.58 / $5,492.31 / $12,307.88
| Facility | | $1,135.58 | $5,492.31 | $12,307.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,749.00 / $9,458.00 / $16,490.00
| Facility | | $4,749.00 | $9,458.00 | $16,490.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.50 / $2,864.48 / $6,145.12
| Facility | | $1,184.50 | $2,864.48 | $6,145.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.06 / $94.06 / $94.06
| Facility | AS | $94.06 | $94.06 | $94.06 |
- 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 |