- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.89 / $4,512.50 / $10,079.72
| Facility | | $1,223.89 | $4,512.50 | $10,079.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $9,110.00 / $19,050.00
| Facility | | $4,977.00 | $9,110.00 | $19,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.22 / $2,472.40 / $10,203.75
| Facility | | $1,067.22 | $2,472.40 | $10,203.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $105.84 / $105.84 / $105.84
| Facility | AS | $105.84 | $105.84 | $105.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,587.03
| Facility | | $3,028.00 | $7,457.00 | $14,587.03 |