- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.36 / $3,907.00 / $7,996.00
| Facility | | $1,068.36 | $3,907.00 | $7,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,517.00 / $14,717.03
| Facility | | $2,224.00 | $4,517.00 | $14,717.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.48 / $1,360.79 / $4,189.30
| Facility | | $831.48 | $1,360.79 | $4,189.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.46 / $227.46 / $412.36
| Facility | AS | $227.46 | $227.46 | $412.36 |
- 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 |