- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.95 / $2,650.03 / $16,467.00
| Facility | | $1,317.95 | $2,650.03 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,363.35 / $6,295.05 / $12,579.75
| Facility | | $2,363.35 | $6,295.05 | $12,579.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.22 / $1,526.66 / $2,296.29
| Facility | | $1,004.22 | $1,526.66 | $2,296.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $178.35 / $221.34 / $254.21
| Facility | AS | $178.35 | $221.34 | $254.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,766.00 / $20,341.00 / $25,620.00
| Facility | | $8,766.00 | $20,341.00 | $25,620.00 |