- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,554.05 / $3,739.49 / $7,879.32
| Facility | | $1,554.05 | $3,739.49 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,892.92 / $8,593.09 / $13,917.11
| Facility | | $3,892.92 | $8,593.09 | $13,917.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,784.51
| Facility | | $680.00 | $870.49 | $1,784.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $175.15 / $175.15 / $175.15
| Facility | AS | $175.15 | $175.15 | $175.15 |
- 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 |