- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,722.92 / $4,470.00 / $12,154.00
| Facility | | $1,722.92 | $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 / $2,397.53 / $11,043.00
| Facility | | $55.00 | $2,397.53 | $11,043.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $340.59 / $639.28 / $639.28
| Facility | AS | $340.59 | $639.28 | $639.28 |
- 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 |