- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.91 / $5,560.00 / $10,253.00
| Facility | | $1,595.91 | $5,560.00 | $10,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.68 / $1,595.92 / $15,556.33
| Facility | | $805.68 | $1,595.92 | $15,556.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $220.87 / $1,196.53 / $1,196.53
| Facility | AS | $220.87 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $10,781.00
| Facility | | $2,156.00 | $4,000.00 | $10,781.00 |