- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,477.67 / $4,908.00 / $12,154.00
| Facility | | $1,477.67 | $4,908.00 | $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
- $1,039.93 / $1,705.82 / $3,449.55
| Facility | | $1,039.93 | $1,705.82 | $3,449.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $285.02 / $513.03 / $513.03
| Facility | AS | $285.02 | $513.03 | $513.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.00 / $3,527.00 / $6,854.00
| Facility | | $1,708.00 | $3,527.00 | $6,854.00 |