- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.67 / $4,908.00 / $12,154.00
| Facility | | $1,087.67 | $4,908.00 | $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
- $750.34 / $1,339.44 / $7,903.00
| Facility | | $750.34 | $1,339.44 | $7,903.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.70 / $417.06 / $417.06
| Facility | AS | $218.70 | $417.06 | $417.06 |
- 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 |