- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.39 / $4,124.77 / $8,834.60
| Facility | | $714.39 | $4,124.77 | $8,834.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,881.00 / $13,523.26
| Facility | | $3,302.10 | $5,881.00 | $13,523.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.50 / $1,688.36 / $2,438.72
| Facility | | $842.50 | $1,688.36 | $2,438.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.00 / $56.00 / $56.00
| Facility | AS | $56.00 | $56.00 | $56.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |