- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.33 / $5,557.51 / $10,555.00
| Facility | | $1,054.33 | $5,557.51 | $10,555.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,888.00 / $8,484.00 / $17,206.00
| Facility | | $3,888.00 | $8,484.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.55 / $2,773.21 / $5,378.55
| Facility | | $958.55 | $2,773.21 | $5,378.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $65.17 / $65.17 / $65.17
| Facility | AS | $65.17 | $65.17 | $65.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,194.50 / $6,927.00 / $13,246.50
| Facility | | $2,194.50 | $6,927.00 | $13,246.50 |