- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.92 / $3,803.00 / $8,000.00
| Facility | | $946.92 | $3,803.00 | $8,000.00 |
- 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
- $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
- $82.62 / $82.62 / $82.62
| Facility | AS | $82.62 | $82.62 | $82.62 |
- 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 |