- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,358.07 / $4,419.00 / $10,454.00
| Facility | | $1,358.07 | $4,419.00 | $10,454.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,749.00 / $9,877.00 / $17,400.00
| Facility | | $4,749.00 | $9,877.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.44 / $3,632.03 / $5,441.47
| Facility | | $1,154.44 | $3,632.03 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.57 / $114.57 / $114.57
| Facility | AS | $114.57 | $114.57 | $114.57 |
- 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 |