- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.97 / $4,288.80 / $17,297.98
| Facility | | $1,366.97 | $4,288.80 | $17,297.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,467.00 / $9,283.00
| Facility | | $2,056.00 | $5,467.00 | $9,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,607.68 / $16,223.75 / $16,223.75
| Facility | | $4,607.68 | $16,223.75 | $16,223.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $179.04 / $1,537.78 / $1,537.78
| Facility | AS | $179.04 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |