- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.05 / $4,778.00 / $9,823.00
| Facility | | $1,238.05 | $4,778.00 | $9,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,650.00 / $10,043.00
| Facility | | $2,114.00 | $4,650.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.32 / $1,390.27 / $7,042.00
| Facility | | $636.32 | $1,390.27 | $7,042.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $235.02 / $1,196.53 / $1,196.53
| Facility | AS | $235.02 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $9,185.00
| Facility | | $1,748.00 | $3,502.00 | $9,185.00 |