- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,453.05 / $5,200.50 / $7,602.00
| Facility | | $1,453.05 | $5,200.50 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,820.00 / $9,153.00 / $14,914.00
| Facility | | $4,820.00 | $9,153.00 | $14,914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $12,097.52 / $12,371.84
| Facility | | $2,800.00 | $12,097.52 | $12,371.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $340.11 / $648.67 / $648.67
| Facility | AS | $340.11 | $648.67 | $648.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |