- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.50 / $4,106.00 / $8,340.00
| Facility | | $1,008.50 | $4,106.00 | $8,340.00 |
- 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
- $859.48 / $1,264.58 / $1,909.39
| Facility | | $859.48 | $1,264.58 | $1,909.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.26 / $85.26 / $85.26
| Facility | AS | $85.26 | $85.26 | $85.26 |
- 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 |