- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.33 / $4,112.00 / $8,133.00
| Facility | | $1,077.33 | $4,112.00 | $8,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,566.00 / $19,382.01
| Facility | | $5,195.00 | $10,566.00 | $19,382.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.26 / $1,033.26 / $1,431.23
| Facility | | $1,033.26 | $1,033.26 | $1,431.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.48 / $101.48 / $101.48
| Facility | AS | $101.48 | $101.48 | $101.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |