- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $4,856.00 / $18,600.00
| Facility | | $1,456.00 | $4,856.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,003.53 / $18,972.31 / $30,208.54
| Facility | | $12,003.53 | $18,972.31 | $30,208.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.43 / $1,877.64 / $8,986.49
| Facility | | $1,191.43 | $1,877.64 | $8,986.49 |
- 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 |