- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.22 / $3,093.50 / $7,980.07
| Facility | | $616.22 | $3,093.50 | $7,980.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $10,517.23
| Facility | | $3,248.00 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.20 / $1,574.05 / $2,172.58
| Facility | | $883.20 | $1,574.05 | $2,172.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $72.42 / $72.42 / $72.42
| Facility | AS | $72.42 | $72.42 | $72.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $7,934.00
| Facility | | $1,902.00 | $3,764.00 | $7,934.00 |