- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.12 / $4,261.00 / $12,154.00
| Facility | | $1,472.12 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.00 / $4,344.00 / $10,123.00
| Facility | | $2,232.00 | $4,344.00 | $10,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.50 / $1,818.82 / $3,532.00
| Facility | | $1,204.50 | $1,818.82 | $3,532.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $344.38 / $638.23 / $638.23
| Facility | AS | $344.38 | $638.23 | $638.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,874.00 / $5,813.00
| Facility | | $1,438.00 | $2,874.00 | $5,813.00 |