- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.60 / $4,933.00 / $10,750.00
| Facility | | $1,246.60 | $4,933.00 | $10,750.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,264.00 / $12,274.00
| Facility | | $4,100.00 | $7,264.00 | $12,274.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,322.02 / $2,708.78 / $3,869.49
| Facility | | $2,322.02 | $2,708.78 | $3,869.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.83 / $97.83 / $97.83
| Facility | AS | $97.83 | $97.83 | $97.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |