- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.50 / $3,850.00 / $8,118.50
| Facility | | $887.50 | $3,850.00 | $8,118.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,548.00 / $11,253.00
| Facility | | $3,302.10 | $6,548.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.38 / $675.38 / $758.69
| Facility | | $675.38 | $675.38 | $758.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $65.84 / $65.84 / $65.84
| Facility | AS | $65.84 | $65.84 | $65.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.00 / $3,764.00 / $7,934.00
| Facility | | $1,832.00 | $3,764.00 | $7,934.00 |