- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.00 / $3,596.00 / $7,920.26
| Facility | | $1,181.00 | $3,596.00 | $7,920.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,586.50 / $11,043.50 / $22,081.36
| Facility | | $5,586.50 | $11,043.50 | $22,081.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.92 / $1,234.92 / $1,705.17
| Facility | | $1,234.92 | $1,234.92 | $1,705.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.91 / $120.91 / $120.91
| Facility | AS | $120.91 | $120.91 | $120.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $10,133.00 / $19,962.00
| Facility | | $4,873.00 | $10,133.00 | $19,962.00 |