- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.88 / $3,606.50 / $8,238.00
| Facility | | $1,012.88 | $3,606.50 | $8,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,458.00 / $17,424.00
| Facility | | $5,470.00 | $9,458.00 | $17,424.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.92 / $1,864.54 / $2,603.61
| Facility | | $1,134.92 | $1,864.54 | $2,603.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $93.43 / $93.43 / $93.43
| Facility | AS | $93.43 | $93.43 | $93.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |