- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,795.61 / $4,610.00 / $12,154.00
| Facility | | $1,795.61 | $4,610.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $4,286.00 / $10,043.00
| Facility | | $2,234.00 | $4,286.00 | $10,043.00 |
- 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
- $1,795.61 / $2,736.33 / $5,051.37
| Facility | | $1,795.61 | $2,736.33 | $5,051.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $488.41 / $882.55 / $882.55
| Facility | AS | $488.41 | $882.55 | $882.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.00 / $3,300.00 / $11,186.00
| Facility | | $1,189.00 | $3,300.00 | $11,186.00 |