- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.80 / $3,854.78 / $8,819.64
| Facility | | $822.80 | $3,854.78 | $8,819.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $7,786.96 / $7,786.96 / $7,786.96
| Facility | AS | $7,786.96 | $7,786.96 | $7,786.96 |
- 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
- $867.38 / $1,722.92 / $2,527.24
| Facility | | $867.38 | $1,722.92 | $2,527.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.23 / $63.23 / $63.23
| Facility | AS | $63.23 | $63.23 | $63.23 |
- 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 |