- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.75 / $5,346.45 / $11,098.69
| Facility | | $1,079.75 | $5,346.45 | $11,098.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,363.00 / $15,579.70
| Facility | | $4,100.00 | $7,363.00 | $15,579.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.25 / $2,662.45 / $3,376.72
| Facility | | $2,344.25 | $2,662.45 | $3,376.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.36 / $94.36 / $94.36
| Facility | AS | $94.36 | $94.36 | $94.36 |
- 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 |