- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,885.58 / $3,889.50 / $8,130.00
| Facility | | $1,885.58 | $3,889.50 | $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
- $2,072.50 / $2,461.17 / $5,582.85
| Facility | | $2,072.50 | $2,461.17 | $5,582.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.07 / $202.07 / $202.07
| Facility | AS | $202.07 | $202.07 | $202.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,152.00
| Facility | | $1,292.00 | $3,325.00 | $8,152.00 |