- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.81 / $4,452.00 / $10,920.86
| Facility | | $1,074.81 | $4,452.00 | $10,920.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,128.50 / $10,010.55 / $23,081.93
| Facility | | $4,128.50 | $10,010.55 | $23,081.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.50 / $950.00 / $1,017.08
| Facility | | $887.50 | $950.00 | $1,017.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.81 / $100.81 / $100.81
| Facility | AS | $100.81 | $100.81 | $100.81 |
- 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 |