- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.85 / $3,627.17 / $8,130.00
| Facility | | $1,511.85 | $3,627.17 | $8,130.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.00 / $8,584.00 / $17,400.00
| Facility | | $4,568.00 | $8,584.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.27 / $1,822.46 / $4,152.69
| Facility | | $1,532.27 | $1,822.46 | $4,152.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $149.80 / $149.80 / $149.80
| Facility | AS | $149.80 | $149.80 | $149.80 |
- 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 |