- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,549.20 / $3,695.07 / $8,238.00
| Facility | | $1,549.20 | $3,695.07 | $8,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.21 / $8,766.98 / $14,405.53
| Facility | | $4,636.21 | $8,766.98 | $14,405.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,568.86 / $1,568.86 / $4,154.36
| Facility | | $1,568.86 | $1,568.86 | $4,154.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.96 / $151.96 / $151.96
| Facility | AS | $151.96 | $151.96 | $151.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,152.00
| Facility | | $1,292.00 | $3,325.00 | $8,152.00 |