- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.91 / $3,683.00 / $12,600.00
| Facility | | $1,016.91 | $3,683.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,227.34 / $8,304.37 / $13,120.82
| Facility | | $5,227.34 | $8,304.37 | $13,120.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.32 / $1,088.48 / $6,840.79
| Facility | | $825.32 | $1,088.48 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $185.67 / $849.00 / $849.00
| Facility | AS | $185.67 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,054.00 / $7,077.94
| Facility | | $1,157.00 | $4,054.00 | $7,077.94 |