- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.50 / $3,401.00 / $8,042.03
| Facility | | $792.50 | $3,401.00 | $8,042.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.00 / $4,133.00 / $8,240.00
| Facility | | $2,137.00 | $4,133.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.97 / $850.29 / $1,141.83
| Facility | | $714.97 | $850.29 | $1,141.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $62.30 / $62.30 / $62.30
| Facility | AS | $62.30 | $62.30 | $62.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,966.00 / $3,635.00 / $7,381.05
| Facility | | $1,966.00 | $3,635.00 | $7,381.05 |