- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,205.03 / $4,792.50 / $9,458.80
| Facility | | $1,205.03 | $4,792.50 | $9,458.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.95 / $8,522.55 / $13,917.11
| Facility | | $3,573.95 | $8,522.55 | $13,917.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,100.00
| Facility | | $680.00 | $870.49 | $1,100.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.84 / $104.84 / $104.84
| Facility | AS | $104.84 | $104.84 | $104.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |