- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,786.30 / $10,964.78
| Facility | | $1,047.13 | $4,786.30 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,698.24 / $1,995.26
| Facility | | $691.83 | $1,698.24 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,585.78 / $11,748.98
| Facility | | $2,290.87 | $7,585.78 | $11,748.98 |