- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.00 / $4,261.00 / $8,622.00
| Facility | | $1,131.00 | $4,261.00 | $8,622.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,892.92 / $8,681.06 / $13,917.11
| Facility | | $3,892.92 | $8,681.06 | $13,917.11 |
- 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
- $102.94 / $102.94 / $102.94
| Facility | AS | $102.94 | $102.94 | $102.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.50 / $4,276.00 / $8,976.50
| Facility | | $1,454.50 | $4,276.00 | $8,976.50 |