- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.28 / $5,560.00 / $10,888.81
| Facility | | $1,161.28 | $5,560.00 | $10,888.81 |
- 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
- $851.85 / $1,714.92 / $6,310.00
| Facility | | $851.85 | $1,714.92 | $6,310.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $246.94 / $2,632.21 / $2,632.21
| Facility | AS | $246.94 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,566.00 / $12,989.00
| Facility | | $2,426.00 | $4,566.00 | $12,989.00 |