- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,526.20 / $4,137.00 / $12,154.00
| Facility | | $1,526.20 | $4,137.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.85 / $3,861.00 / $10,011.00
| Facility | | $1,850.85 | $3,861.00 | $10,011.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,115.64 / $11,043.00
| Facility | | $55.00 | $2,115.64 | $11,043.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $298.16 / $552.54 / $552.54
| Facility | AS | $298.16 | $552.54 | $552.54 |
- 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 |