- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,614.00 / $4,003.67 / $8,000.00
| Facility | | $1,614.00 | $4,003.67 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,548.00 / $11,253.00
| Facility | | $3,302.10 | $6,548.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,721.49 / $1,773.58 / $1,937.60
| Facility | | $1,721.49 | $1,773.58 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $175.11 / $175.11 / $175.11
| Facility | AS | $175.11 | $175.11 | $175.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.00 / $3,764.00 / $7,934.00
| Facility | | $1,832.00 | $3,764.00 | $7,934.00 |