- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.56 / $3,441.51 / $8,074.63
| Facility | | $933.56 | $3,441.51 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,085.00 / $11,898.00 / $22,807.60
| Facility | | $6,085.00 | $11,898.00 | $22,807.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.55 / $1,011.55 / $1,402.31
| Facility | | $1,011.55 | $1,011.55 | $1,402.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $99.43 / $99.43 / $99.43
| Facility | AS | $99.43 | $99.43 | $99.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |