- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.62 / $3,489.22 / $8,074.63
| Facility | | $1,040.62 | $3,489.22 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $13,096.00 / $25,103.02
| Facility | | $6,153.00 | $13,096.00 | $25,103.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.65 / $1,040.65 / $1,440.17
| Facility | | $1,040.65 | $1,040.65 | $1,440.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.12 / $102.12 / $102.12
| Facility | AS | $102.12 | $102.12 | $102.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |