- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.47 / $3,481.00 / $8,500.00
| Facility | | $827.47 | $3,481.00 | $8,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $11,136.00
| Facility | | $3,248.00 | $5,196.00 | $11,136.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.69 / $1,574.05 / $2,172.58
| Facility | | $910.69 | $1,574.05 | $2,172.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $64.56 / $64.56 / $64.56
| Facility | AS | $64.56 | $64.56 | $64.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |