- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.82 / $3,606.50 / $8,074.63
| Facility | | $1,115.82 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,088.00 / $9,565.00 / $17,206.00
| Facility | | $5,088.00 | $9,565.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.24 / $1,122.24 / $1,552.16
| Facility | | $1,122.24 | $1,122.24 | $1,552.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.06 / $110.06 / $110.06
| Facility | AS | $110.06 | $110.06 | $110.06 |
- 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 |