- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,262.33 / $4,700.50 / $8,861.13
| Facility | | $1,262.33 | $4,700.50 | $8,861.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,347.00 / $10,074.50 / $20,563.12
| Facility | | $4,347.00 | $10,074.50 | $20,563.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,099.81 / $1,099.81 / $2,919.18
| Facility | | $1,099.81 | $1,099.81 | $2,919.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $106.63 / $106.63 / $106.63
| Facility | AS | $106.63 | $106.63 | $106.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,966.00 / $8,246.50 / $14,473.61
| Facility | | $3,966.00 | $8,246.50 | $14,473.61 |