- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.73 / $2,704.20 / $6,681.00
| Facility | | $1,250.73 | $2,704.20 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,562.00 / $4,657.00 / $7,950.00
| Facility | | $2,562.00 | $4,657.00 | $7,950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,601.35 / $12,623.50 / $26,542.00
| Facility | | $3,601.35 | $12,623.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $197.65 / $1,196.53 / $1,196.53
| Facility | AS | $197.65 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.00 / $4,567.00 / $7,669.00
| Facility | | $2,259.00 | $4,567.00 | $7,669.00 |