- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.88 / $3,695.07 / $7,879.32
| Facility | | $1,548.88 | $3,695.07 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $8,239.18 / $14,433.40
| Facility | | $3,671.00 | $8,239.18 | $14,433.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,751.21
| Facility | | $680.00 | $870.49 | $1,751.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.20 / $171.20 / $171.20
| Facility | AS | $171.20 | $171.20 | $171.20 |
- 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 |