- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.75 / $4,243.50 / $8,788.63
| Facility | | $1,424.75 | $4,243.50 | $8,788.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $9,877.00 / $17,400.00
| Facility | | $6,996.00 | $9,877.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.50 / $3,520.57 / $6,247.00
| Facility | | $1,828.50 | $3,520.57 | $6,247.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $135.37 / $135.37 / $135.37
| Facility | AS | $135.37 | $135.37 | $135.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,600.00 / $14,242.22
| Facility | | $3,028.00 | $7,600.00 | $14,242.22 |