- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.32 / $3,724.07 / $8,074.63
| Facility | | $1,534.32 | $3,724.07 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,754.10 / $16,104.00 / $28,048.48
| Facility | | $7,754.10 | $16,104.00 | $28,048.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.89 / $2,000.00 / $4,890.73
| Facility | | $1,784.89 | $2,000.00 | $4,890.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.02 / $177.02 / $177.02
| Facility | AS | $177.02 | $177.02 | $177.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $19,562.00
| Facility | | $4,505.00 | $10,133.00 | $19,562.00 |