- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.15 / $3,108.50 / $7,245.00
| Facility | | $1,006.15 | $3,108.50 | $7,245.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,218.05 / $6,011.31 / $10,556.91
| Facility | | $3,218.05 | $6,011.31 | $10,556.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,100.00
| Facility | | $680.00 | $870.49 | $1,100.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.32 / $94.32 / $94.32
| Facility | AS | $94.32 | $94.32 | $94.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.50 / $2,335.00 / $5,253.50
| Facility | | $815.50 | $2,335.00 | $5,253.50 |