- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.80 / $5,389.00 / $12,154.00
| Facility | | $1,538.80 | $5,389.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.00 / $5,208.00 / $11,904.00
| Facility | | $2,232.00 | $5,208.00 | $11,904.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,214.00 / $11,043.00
| Facility | | $55.00 | $2,214.00 | $11,043.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $304.58 / $571.47 / $571.47
| Facility | AS | $304.58 | $571.47 | $571.47 |
- 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 |