- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.31 / $3,606.50 / $8,238.00
| Facility | | $1,047.31 | $3,606.50 | $8,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $9,992.00 / $17,206.00
| Facility | | $4,755.00 | $9,992.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.11 / $1,050.11 / $1,451.73
| Facility | | $1,050.11 | $1,050.11 | $1,451.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Facility | AS | $102.94 | $102.94 | $102.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |