- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.82 / $3,942.00 / $8,572.13
| Facility | | $1,060.82 | $3,942.00 | $8,572.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,559.00 / $11,909.00
| Facility | | $3,302.10 | $6,559.00 | $11,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.14 / $1,207.14 / $2,000.00
| Facility | | $1,207.14 | $1,207.14 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.75 / $119.75 / $119.75
| Facility | AS | $119.75 | $119.75 | $119.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |