- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,255.23 / $5,054.00 / $10,350.50
| Facility | | $1,255.23 | $5,054.00 | $10,350.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,264.00 / $14,034.00
| Facility | | $3,877.00 | $7,264.00 | $14,034.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,166.50 / $3,166.50 / $4,191.89
| Facility | | $3,166.50 | $3,166.50 | $4,191.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Facility | AS | $102.94 | $102.94 | $102.94 |
- 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 |