- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.69 / $4,510.50 / $9,349.83
| Facility | | $1,210.69 | $4,510.50 | $9,349.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,516.00 / $11,064.61 / $25,182.35
| Facility | | $4,516.00 | $11,064.61 | $25,182.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,082.47
| Facility | | $895.00 | $950.00 | $1,082.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $106.37 / $106.37 / $106.37
| Facility | AS | $106.37 | $106.37 | $106.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |