- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.32 / $4,454.00 / $9,364.75
| Facility | | $1,470.32 | $4,454.00 | $9,364.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $9,565.00 / $17,400.00
| Facility | | $6,996.00 | $9,565.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.00 / $3,939.77 / $5,792.00
| Facility | | $2,211.00 | $3,939.77 | $5,792.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $136.44 / $136.44 / $136.44
| Facility | AS | $136.44 | $136.44 | $136.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,499.00 / $14,242.22
| Facility | | $3,028.00 | $7,499.00 | $14,242.22 |