- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.00 / $3,214.00 / $8,000.00
| Facility | | $1,098.00 | $3,214.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.14 / $1,195.20 / $5,628.30
| Facility | | $740.14 | $1,195.20 | $5,628.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.37 / $202.37 / $497.27
| Facility | AS | $202.37 | $202.37 | $497.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.61 / $1,908.00 / $5,200.00
| Facility | | $1,469.61 | $1,908.00 | $5,200.00 |