- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.63 / $3,683.00 / $8,016.63
| Facility | | $1,150.63 | $3,683.00 | $8,016.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,443.89 / $11,982.00 / $22,081.36
| Facility | | $6,443.89 | $11,982.00 | $22,081.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.40 / $1,283.40 / $1,772.47
| Facility | | $1,283.40 | $1,283.40 | $1,772.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.68 / $125.68 / $125.68
| Facility | AS | $125.68 | $125.68 | $125.68 |
- 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 |