- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.50 / $4,819.07 / $9,696.50
| Facility | | $952.50 | $4,819.07 | $9,696.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,079.00 / $7,264.00 / $12,538.00
| Facility | | $4,079.00 | $7,264.00 | $12,538.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,166.50 / $3,801.95 / $4,493.21
| Facility | | $3,166.50 | $3,801.95 | $4,493.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.00 / $73.00 / $73.00
| Facility | AS | $73.00 | $73.00 | $73.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,013.00 / $8,246.50 / $14,473.61
| Facility | | $4,013.00 | $8,246.50 | $14,473.61 |