- 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
- $2,884.03 / $7,762.47 / $16,982.44
| Facility | | $2,884.03 | $7,762.47 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,089.30 / $12,589.25
| Facility | | $1,023.29 | $2,089.30 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Facility | AS | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $8,317.64 / $17,782.79
| Facility | | $2,691.53 | $8,317.64 | $17,782.79 |