- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.66 / $3,968.50 / $8,088.46
| Facility | | $894.66 | $3,968.50 | $8,088.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $10,517.23
| Facility | | $3,248.00 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $1,264.58 / $1,909.39
| Facility | | $843.00 | $1,264.58 | $1,909.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $78.67 / $78.67 / $78.67
| Facility | AS | $78.67 | $78.67 | $78.67 |
- 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 |