- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.89 / $4,470.00 / $12,154.00
| Facility | | $1,638.89 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $12,235.48
| Facility | | $2,224.00 | $4,490.00 | $12,235.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.35 / $2,458.34 / $7,294.00
| Facility | | $1,438.35 | $2,458.34 | $7,294.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $401.65 / $746.31 / $746.31
| Facility | AS | $401.65 | $746.31 | $746.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,578.00 / $5,252.00 / $19,082.00
| Facility | | $2,578.00 | $5,252.00 | $19,082.00 |