- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,837.00 / $3,798.58 / $8,331.00
| Facility | | $1,837.00 | $3,798.58 | $8,331.00 |
- 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
- $2,240.66 / $2,269.32 / $4,890.73
| Facility | | $2,240.66 | $2,269.32 | $4,890.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $225.03 / $225.03 / $225.03
| Facility | AS | $225.03 | $225.03 | $225.03 |
- 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 |