- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.06 / $3,351.02 / $7,879.32
| Facility | | $1,068.06 | $3,351.02 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $7,979.00 / $14,433.40
| Facility | | $3,671.00 | $7,979.00 | $14,433.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,138.50
| Facility | | $680.00 | $870.49 | $1,138.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.55 / $111.55 / $111.55
| Facility | AS | $111.55 | $111.55 | $111.55 |
- 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 |