- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.18 / $4,038.50 / $8,561.00
| Facility | | $770.18 | $4,038.50 | $8,561.00 |
- 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 / $1,499.51 / $2,172.58
| Facility | | $883.20 | $1,499.51 | $2,172.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.55 / $55.55 / $55.55
| Facility | AS | $55.55 | $55.55 | $55.55 |
- 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 |