- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.00 / $4,100.00 / $8,500.00
| Facility | | $1,242.00 | $4,100.00 | $8,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,128.50 / $10,010.55 / $24,062.91
| Facility | | $4,128.50 | $10,010.55 | $24,062.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,096.83
| Facility | | $895.00 | $950.00 | $1,096.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.68 / $109.68 / $109.68
| Facility | AS | $109.68 | $109.68 | $109.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |