- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.45 / $3,327.50 / $8,098.50
| Facility | | $941.45 | $3,327.50 | $8,098.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,516.00 / $12,386.00 / $55,752.34
| Facility | | $4,516.00 | $12,386.00 | $55,752.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,021.03
| Facility | | $895.00 | $950.00 | $1,021.03 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.07 / $100.07 / $100.07
| Facility | AS | $100.07 | $100.07 | $100.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,858.50 / $9,642.00 / $19,106.00
| Facility | | $3,858.50 | $9,642.00 | $19,106.00 |