- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,677.35 / $11,748.98
| Facility | | $1,000.00 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $22,387.21
| Facility | | $3,548.13 | $10,471.29 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,290.87 / $5,623.41
| Facility | | $1,096.48 | $2,290.87 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,982.44
| Facility | | $2,454.71 | $7,244.36 | $16,982.44 |