- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.40 / $3,606.50 / $8,074.63
| Facility | | $725.40 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $7,264.00 / $12,538.00
| Facility | | $4,452.00 | $7,264.00 | $12,538.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.10 / $919.10 / $4,127.25
| Facility | | $919.10 | $919.10 | $4,127.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $65.17 / $65.17 / $65.17
| Facility | AS | $65.17 | $65.17 | $65.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,273.00 / $14,705.00
| Facility | | $4,062.00 | $8,273.00 | $14,705.00 |