- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,750.27 / $4,243.50 / $8,572.13
| Facility | | $1,750.27 | $4,243.50 | $8,572.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $9,644.00 / $17,206.00
| Facility | | $6,996.00 | $9,644.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,963.31 / $2,000.00 / $4,890.73
| Facility | | $1,963.31 | $2,000.00 | $4,890.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.61 / $194.61 / $194.61
| Facility | AS | $194.61 | $194.61 | $194.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |