- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,639.57 / $7,000.67 / $13,806.76
| Facility | | $1,639.57 | $7,000.67 | $13,806.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,359.00 / $17,190.00
| Facility | | $3,877.00 | $7,359.00 | $17,190.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,380.75 / $3,810.85 / $4,683.03
| Facility | | $3,380.75 | $3,810.85 | $4,683.03 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.86 / $108.86 / $108.86
| Facility | AS | $108.86 | $108.86 | $108.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,759.00 / $12,241.00
| Facility | | $3,206.00 | $6,759.00 | $12,241.00 |