- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,308.92 / $4,487.00 / $9,179.50
| Facility | | $2,308.92 | $4,487.00 | $9,179.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,923.03 / $2,923.03 / $4,080.21
| Facility | | $2,923.03 | $2,923.03 | $4,080.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $289.31 / $289.31 / $289.31
| Facility | AS | $289.31 | $289.31 | $289.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |