- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,580.97 / $4,795.46 / $10,919.32
| Facility | | $1,580.97 | $4,795.46 | $10,919.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $9,219.00 / $17,206.00
| Facility | | $4,977.00 | $9,219.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.78 / $2,472.40 / $9,859.61
| Facility | | $1,498.78 | $2,472.40 | $9,859.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $149.31 / $149.31 / $149.31
| Facility | AS | $149.31 | $149.31 | $149.31 |
- 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 |