- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.38 / $3,606.50 / $8,171.00
| Facility | | $845.38 | $3,606.50 | $8,171.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,085.00 / $11,898.00 / $22,008.00
| Facility | | $6,085.00 | $11,898.00 | $22,008.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.58 / $891.58 / $1,234.05
| Facility | | $891.58 | $891.58 | $1,234.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.50 / $87.50 / $87.50
| Facility | AS | $87.50 | $87.50 | $87.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |