- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,520.57 / $4,836.34 / $12,174.00
| Facility | | $1,520.57 | $4,836.34 | $12,174.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,443.89 / $12,040.00 / $23,008.27
| Facility | | $6,443.89 | $12,040.00 | $23,008.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $3,972.03 / $10,047.00
| Facility | | $2,321.00 | $3,972.03 | $10,047.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.66 / $147.66 / $147.66
| Facility | AS | $147.66 | $147.66 | $147.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,500.00 / $8,198.00
| Facility | | $1,403.00 | $3,500.00 | $8,198.00 |