- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,099.80 / $4,777.00 / $10,572.00
| Facility | | $1,099.80 | $4,777.00 | $10,572.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,280.00 / $11,909.00
| Facility | | $3,302.10 | $5,280.00 | $11,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.89 / $2,034.32 / $2,807.87
| Facility | | $1,394.89 | $2,034.32 | $2,807.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.66 / $94.66 / $94.66
| Facility | AS | $94.66 | $94.66 | $94.66 |
- 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 |