- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,893.17 / $4,716.00 / $9,823.00
| Facility | | $1,893.17 | $4,716.00 | $9,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $14,717.03
| Facility | | $2,224.00 | $4,490.00 | $14,717.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.73 / $2,650.44 / $5,246.00
| Facility | | $1,581.73 | $2,650.44 | $5,246.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $472.53 / $472.53 / $858.79
| Facility | AS | $472.53 | $472.53 | $858.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.30 / $4,000.00 / $9,817.00
| Facility | | $1,433.30 | $4,000.00 | $9,817.00 |