- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.53 / $3,684.00 / $12,600.00
| Facility | | $1,182.53 | $3,684.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,133.92 / $9,567.08 / $15,005.42
| Facility | | $6,133.92 | $9,567.08 | $15,005.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.69 / $1,692.62 / $9,412.67
| Facility | | $1,100.69 | $1,692.62 | $9,412.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,442.13 / $1,442.13 / $1,442.13
| Facility | AS | $1,442.13 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.00 / $5,524.00 / $9,232.95
| Facility | | $1,280.00 | $5,524.00 | $9,232.95 |