- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.38 / $4,470.00 / $12,154.00
| Facility | | $2,321.38 | $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
- $1,120.00 / $3,500.00 / $8,652.87
| Facility | | $1,120.00 | $3,500.00 | $8,652.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $660.70 / $1,279.93 / $1,279.93
| Facility | AS | $660.70 | $1,279.93 | $1,279.93 |
- 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 |