- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.08 / $3,993.06 / $8,238.00
| Facility | | $1,937.08 | $3,993.06 | $8,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,321.00 / $11,397.50 / $19,382.01
| Facility | | $5,321.00 | $11,397.50 | $19,382.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,287.73 / $2,287.73 / $3,169.52
| Facility | | $2,287.73 | $2,287.73 | $3,169.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $224.74 / $224.74 / $224.74
| Facility | AS | $224.74 | $224.74 | $224.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |