- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,801.67 / $4,243.50 / $8,788.63
| Facility | | $1,801.67 | $4,243.50 | $8,788.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $9,565.00 / $17,774.00
| Facility | | $6,996.00 | $9,565.00 | $17,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,105.50 / $3,047.94 / $4,528.38
| Facility | | $2,105.50 | $3,047.94 | $4,528.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.10 / $184.10 / $184.10
| Facility | AS | $184.10 | $184.10 | $184.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,469.00 / $14,242.22
| Facility | | $3,028.00 | $7,469.00 | $14,242.22 |