- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,575.43 / $3,825.41 / $8,074.63
| Facility | | $1,575.43 | $3,825.41 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,088.00 / $9,565.00 / $17,206.00
| Facility | | $5,088.00 | $9,565.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,801.46 / $1,801.46 / $2,493.34
| Facility | | $1,801.46 | $1,801.46 | $2,493.34 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.79 / $176.79 / $176.79
| Facility | AS | $176.79 | $176.79 | $176.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |