- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.76 / $4,828.00 / $8,622.00
| Facility | | $1,070.76 | $4,828.00 | $8,622.00 |
- 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
- $3,173.57 / $3,801.95 / $4,493.21
| Facility | | $3,173.57 | $3,801.95 | $4,493.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $88.40 / $88.40 / $88.40
| Facility | AS | $88.40 | $88.40 | $88.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,273.00 / $14,705.00
| Facility | | $4,062.00 | $8,273.00 | $14,705.00 |