- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,262.03 / $3,684.00 / $18,600.00
| Facility | | $1,262.03 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.19 / $3,224.30 / $5,131.02
| Facility | | $2,044.19 | $3,224.30 | $5,131.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.29 / $2,744.00 / $13,541.98
| Facility | | $1,161.29 | $2,744.00 | $13,541.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,314.53 / $1,314.53 / $1,314.53
| Facility | AS | $1,314.53 | $1,314.53 | $1,314.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.00 / $6,980.00 / $13,541.98
| Facility | | $1,570.00 | $6,980.00 | $13,541.98 |