- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.50 / $4,691.76 / $9,978.72
| Facility | | $1,041.50 | $4,691.76 | $9,978.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,278.00 / $12,915.00
| Facility | | $3,877.00 | $7,278.00 | $12,915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,322.02 / $2,497.46 / $3,376.72
| Facility | | $2,322.02 | $2,497.46 | $3,376.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.50 / $87.50 / $87.50
| Facility | AS | $87.50 | $87.50 | $87.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |