- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.00 / $5,144.00 / $9,823.00
| Facility | | $1,704.00 | $5,144.00 | $9,823.00 |
- 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
- $1,186.67 / $1,942.29 / $21,310.46
| Facility | | $1,186.67 | $1,942.29 | $21,310.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $327.41 / $327.41 / $2,419.88
| Facility | AS | $327.41 | $327.41 | $2,419.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $10,781.00
| Facility | | $2,156.00 | $4,000.00 | $10,781.00 |