- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.42 / $4,147.50 / $9,446.50
| Facility | | $1,208.42 | $4,147.50 | $9,446.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,450.00 / $11,044.05 / $25,201.27
| Facility | | $4,450.00 | $11,044.05 | $25,201.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.50 / $950.00 / $1,129.30
| Facility | | $887.50 | $950.00 | $1,129.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.81 / $111.81 / $111.81
| Facility | AS | $111.81 | $111.81 | $111.81 |
- 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 |