- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,620.10 / $3,617.00 / $7,467.00
| Facility | | $1,620.10 | $3,617.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.08 / $1,062.84 / $3,911.00
| Facility | | $798.08 | $1,062.84 | $3,911.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $211.91 / $211.91 / $383.00
| Facility | AS | $211.91 | $211.91 | $383.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |