- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.83 / $3,495.01 / $8,328.00
| Facility | | $1,065.83 | $3,495.01 | $8,328.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,155.58 / $8,269.50 / $13,211.02
| Facility | | $4,155.58 | $8,269.50 | $13,211.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.68 / $1,196.68 / $1,678.35
| Facility | | $1,196.68 | $1,196.68 | $1,678.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.00 / $119.00 / $119.00
| Facility | AS | $119.00 | $119.00 | $119.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,759.00
| Facility | | $1,403.00 | $3,325.00 | $8,759.00 |