- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.66 / $5,389.00 / $12,154.00
| Facility | | $1,651.66 | $5,389.00 | $12,154.00 |
- 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
- $1,125.68 / $1,946.20 / $5,947.00
| Facility | | $1,125.68 | $1,946.20 | $5,947.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $324.74 / $1,324.34 / $1,324.34
| Facility | AS | $324.74 | $1,324.34 | $1,324.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $10,781.00
| Facility | | $2,156.00 | $4,000.00 | $10,781.00 |