- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.46 / $5,389.00 / $12,154.00
| Facility | | $1,230.46 | $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 / $1,872.61 / $11,043.00
| Facility | | $55.00 | $1,872.61 | $11,043.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $243.06 / $456.42 / $456.42
| Facility | AS | $243.06 | $456.42 | $456.42 |
- 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 |