- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.44 / $3,533.53 / $8,328.00
| Facility | | $1,250.44 | $3,533.53 | $8,328.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,783.17 / $8,580.10 / $13,270.04
| Facility | | $3,783.17 | $8,580.10 | $13,270.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,464.13 / $1,464.13 / $2,056.40
| Facility | | $1,464.13 | $1,464.13 | $2,056.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $145.81 / $145.81 / $145.81
| Facility | AS | $145.81 | $145.81 | $145.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |