- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.00 / $5,144.00 / $9,823.00
| Facility | | $1,704.00 | $5,144.00 | $9,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,517.00 / $12,297.00
| Facility | | $2,224.00 | $4,517.00 | $12,297.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,369.87 / $7,461.52
| Facility | | $55.00 | $1,369.87 | $7,461.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $183.54 / $333.49 / $333.49
| Facility | AS | $183.54 | $333.49 | $333.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,209.00 / $4,390.00 / $12,989.00
| Facility | | $2,209.00 | $4,390.00 | $12,989.00 |