- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,127.26 / $5,036.72 / $16,467.00
| Facility | | $2,127.26 | $5,036.72 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,209.42 / $9,209.42 / $9,209.42
| Facility | | $9,209.42 | $9,209.42 | $9,209.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,903.53 / $2,480.58 / $4,150.68
| Facility | | $1,903.53 | $2,480.58 | $4,150.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $344.61 / $347.28 / $481.69
| Facility | AS | $344.61 | $347.28 | $481.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |