- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,279.48 / $4,908.00 / $9,823.00
| Facility | | $1,279.48 | $4,908.00 | $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
- $813.92 / $1,422.26 / $4,473.70
| Facility | | $813.92 | $1,422.26 | $4,473.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $243.32 / $243.32 / $440.52
| Facility | AS | $243.32 | $243.32 | $440.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,858.00 / $4,000.00 / $11,258.00
| Facility | | $1,858.00 | $4,000.00 | $11,258.00 |