- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.14 / $4,510.50 / $9,109.84
| Facility | | $1,065.14 | $4,510.50 | $9,109.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $12,916.00 / $21,453.35
| Facility | | $6,153.00 | $12,916.00 | $21,453.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.58 / $947.58 / $2,385.78
| Facility | | $947.58 | $947.58 | $2,385.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.87 / $86.87 / $86.87
| Facility | AS | $86.87 | $86.87 | $86.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |