- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,333.40 / $3,596.00 / $8,113.00
| Facility | | $1,333.40 | $3,596.00 | $8,113.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,460.35 / $2,871.23 / $10,462.50
| Facility | | $1,460.35 | $2,871.23 | $10,462.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.35 / $1,377.35 / $3,748.28
| Facility | | $1,377.35 | $1,377.35 | $3,748.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.96 / $134.96 / $134.96
| Facility | AS | $134.96 | $134.96 | $134.96 |
- 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 |