- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.88 / $4,470.00 / $12,154.00
| Facility | | $1,026.88 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,449.00 / $10,043.00
| Facility | | $2,224.00 | $4,449.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.44 / $1,477.21 / $7,500.00
| Facility | | $775.44 | $1,477.21 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.17 / $381.03 / $381.03
| Facility | AS | $215.17 | $381.03 | $381.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,489.00
| Facility | | $1,185.00 | $3,233.00 | $11,489.00 |