- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,997.12 / $4,470.00 / $12,154.00
| Facility | | $1,997.12 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $14,717.03
| Facility | | $2,224.00 | $4,490.00 | $14,717.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.00 / $3,004.16 / $7,903.00
| Facility | | $958.00 | $3,004.16 | $7,903.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $568.48 / $1,101.15 / $1,101.15
| Facility | AS | $568.48 | $1,101.15 | $1,101.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |