- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $5,514.00 / $16,900.00
| Facility | | $1,346.00 | $5,514.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,091.22 / $11,208.10 / $17,846.03
| Facility | | $7,091.22 | $11,208.10 | $17,846.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.55 / $1,479.67 / $10,198.00
| Facility | | $924.55 | $1,479.67 | $10,198.00 |
- 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
- $1,481.00 / $5,524.00 / $9,232.95
| Facility | | $1,481.00 | $5,524.00 | $9,232.95 |