- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.69 / $4,470.00 / $12,154.00
| Facility | | $1,055.69 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,358.00 / $10,043.00
| Facility | | $2,088.00 | $4,358.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,507.69 / $6,335.00
| Facility | | $55.00 | $1,507.69 | $6,335.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $206.63 / $381.48 / $381.48
| Facility | AS | $206.63 | $381.48 | $381.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |