- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.39 / $4,652.50 / $10,294.13
| Facility | | $1,228.39 | $4,652.50 | $10,294.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.00 / $9,030.00 / $17,206.00
| Facility | | $4,568.00 | $9,030.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,256.28 / $3,473.97 / $6,361.38
| Facility | | $2,256.28 | $3,473.97 | $6,361.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.74 / $101.74 / $101.74
| Facility | AS | $101.74 | $101.74 | $101.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,059.00 / $6,668.50 / $12,055.49
| Facility | | $3,059.00 | $6,668.50 | $12,055.49 |