- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.46 / $4,470.00 / $12,154.00
| Facility | | $1,582.46 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $10,123.00
| Facility | | $2,224.00 | $4,490.00 | $10,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,266.89 / $10,826.46
| Facility | | $55.00 | $2,266.89 | $10,826.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $312.68 / $587.05 / $587.05
| Facility | AS | $312.68 | $587.05 | $587.05 |
- 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 |