- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.77 / $4,470.00 / $12,154.00
| Facility | | $1,182.77 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,449.00 / $10,043.00
| Facility | | $2,224.00 | $4,449.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.46 / $1,722.98 / $7,903.00
| Facility | | $856.46 | $1,722.98 | $7,903.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $278.42 / $531.50 / $531.50
| Facility | AS | $278.42 | $531.50 | $531.50 |
- 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 |