- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,505.57 / $4,470.00 / $12,154.00
| Facility | | $2,505.57 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,122.00 / $11,043.00
| Facility | | $55.00 | $3,122.00 | $11,043.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $580.60 / $1,080.10 / $1,080.10
| Facility | AS | $580.60 | $1,080.10 | $1,080.10 |
- 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 |