- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.82 / $3,650.50 / $8,074.63
| Facility | | $1,091.82 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $7,363.00 / $12,538.00
| Facility | | $4,452.00 | $7,363.00 | $12,538.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.33 / $1,068.33 / $4,222.47
| Facility | | $1,068.33 | $1,068.33 | $4,222.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.68 / $103.68 / $103.68
| Facility | AS | $103.68 | $103.68 | $103.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,273.00 / $14,705.00
| Facility | | $4,062.00 | $8,273.00 | $14,705.00 |