- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,209.83 / $6,854.47 / $16,432.20
| Facility | | $1,209.83 | $6,854.47 | $16,432.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $9,458.00 / $17,400.00
| Facility | | $8,512.20 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.79 / $5,257.46 / $5,441.47
| Facility | | $1,043.79 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.83 / $103.83 / $103.83
| Facility | AS | $103.83 | $103.83 | $103.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,399.00 / $12,399.00 / $12,399.00
| Facility | | $12,399.00 | $12,399.00 | $12,399.00 |