- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.01 / $4,470.00 / $12,154.00
| Facility | | $2,095.01 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,279.00 / $10,043.00
| Facility | | $2,088.00 | $4,279.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,838.57 / $11,043.00
| Facility | | $55.00 | $2,838.57 | $11,043.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $486.56 / $904.66 / $904.66
| Facility | AS | $486.56 | $904.66 | $904.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,489.00
| Facility | | $1,185.00 | $3,233.00 | $11,489.00 |