- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.75 / $5,529.77 / $10,112.50
| Facility | | $1,166.75 | $5,529.77 | $10,112.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $10,894.65 / $10,894.65 / $10,894.65
| Facility | AS | $10,894.65 | $10,894.65 | $10,894.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $9,868.00 / $15,579.70
| Facility | | $4,100.00 | $9,868.00 | $15,579.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,040.64 / $3,358.51 / $4,892.42
| Facility | | $3,040.64 | $3,358.51 | $4,892.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.59 / $83.59 / $83.59
| Facility | AS | $83.59 | $83.59 | $83.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,494.00
| Facility | | $3,206.00 | $6,578.00 | $12,494.00 |