- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,038.41 / $4,345.50 / $9,248.34
| Facility | | $1,038.41 | $4,345.50 | $9,248.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,944.00 / $11,253.00
| Facility | | $3,302.10 | $5,944.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $3,796.15
| Facility | | $1,000.00 | $1,000.00 | $3,796.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.46 / $92.46 / $92.46
| Facility | AS | $92.46 | $92.46 | $92.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,920.00 / $9,810.00
| Facility | | $2,637.00 | $5,920.00 | $9,810.00 |