- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,779.00 / $12,600.00
| Facility | | $1,048.00 | $3,779.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,038.84 / $3,222.51 / $5,131.02
| Facility | | $2,038.84 | $3,222.51 | $5,131.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.87 / $1,039.00 / $9,232.95
| Facility | | $280.87 | $1,039.00 | $9,232.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,279.44 / $1,279.44 / $1,279.44
| Facility | AS | $1,279.44 | $1,279.44 | $1,279.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,973.00 / $10,836.00
| Facility | | $1,481.00 | $5,973.00 | $10,836.00 |