- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.72 / $3,269.25 / $7,930.00
| Facility | | $1,130.72 | $3,269.25 | $7,930.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $5,977.00 / $12,538.00
| Facility | | $3,877.00 | $5,977.00 | $12,538.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.30 / $1,751.69 / $3,666.22
| Facility | | $1,133.30 | $1,751.69 | $3,666.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.26 / $112.26 / $112.26
| Facility | AS | $112.26 | $112.26 | $112.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,225.50 / $6,602.50 / $12,808.14
| Facility | | $3,225.50 | $6,602.50 | $12,808.14 |