- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.66 / $3,385.50 / $9,843.84
| Facility | | $1,095.66 | $3,385.50 | $9,843.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $7,194.00 / $13,734.00
| Facility | | $2,897.00 | $7,194.00 | $13,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $27,770.10 / $27,770.10
| Facility | | $2,800.00 | $27,770.10 | $27,770.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $246.94 / $2,632.21 / $2,632.21
| Facility | AS | $246.94 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,959.00 / $8,273.00 / $12,407.00
| Facility | | $3,959.00 | $8,273.00 | $12,407.00 |