- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.63 / $4,474.00 / $8,500.00
| Facility | | $768.63 | $4,474.00 | $8,500.00 |
- 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
- $883.20 / $1,504.78 / $2,172.58
| Facility | | $883.20 | $1,504.78 | $2,172.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.33 / $55.33 / $55.33
| Facility | AS | $55.33 | $55.33 | $55.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $4,326.50 / $7,353.00
| Facility | | $1,981.00 | $4,326.50 | $7,353.00 |