- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.61 / $4,592.52 / $9,841.00
| Facility | | $1,389.61 | $4,592.52 | $9,841.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,363.00 / $15,579.70
| Facility | | $3,877.00 | $7,363.00 | $15,579.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,380.75 / $3,698.56 / $4,977.72
| Facility | | $3,380.75 | $3,698.56 | $4,977.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $121.88 / $121.88 / $121.88
| Facility | AS | $121.88 | $121.88 | $121.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $7,228.00 / $12,241.00
| Facility | | $3,206.00 | $7,228.00 | $12,241.00 |