- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,413.50 / $4,566.00 / $9,678.50
| Facility | | $1,413.50 | $4,566.00 | $9,678.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,247.00 / $10,850.30 / $25,024.67
| Facility | | $4,247.00 | $10,850.30 | $25,024.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,338.52
| Facility | | $895.00 | $950.00 | $1,338.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.94 / $132.94 / $132.94
| Facility | AS | $132.94 | $132.94 | $132.94 |
- 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 |