- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.58 / $2,940.00 / $7,602.00
| Facility | | $1,161.58 | $2,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $4,657.00 / $7,538.00
| Facility | | $2,056.00 | $4,657.00 | $7,538.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $9,117.24 / $9,310.84
| Facility | | $55.00 | $9,117.24 | $9,310.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $183.54 / $357.85 / $357.85
| Facility | AS | $183.54 | $357.85 | $357.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,362.00
| Facility | | $3,964.00 | $8,273.00 | $12,362.00 |