- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.37 / $4,709.00 / $10,356.71
| Facility | | $1,014.37 | $4,709.00 | $10,356.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,218.00 / $9,594.64 / $39,007.80
| Facility | | $3,218.00 | $9,594.64 | $39,007.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.68 / $840.68 / $844.50
| Facility | | $840.68 | $840.68 | $844.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.44 / $83.44 / $83.44
| Facility | AS | $83.44 | $83.44 | $83.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,465.50 / $14,452.01
| Facility | | $3,028.00 | $7,465.50 | $14,452.01 |