- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.63 / $3,684.00 / $18,600.00
| Facility | | $1,201.63 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,343.69 / $11,583.14 / $18,432.97
| Facility | | $7,343.69 | $11,583.14 | $18,432.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.71 / $2,744.00 / $13,541.98
| Facility | | $1,105.71 | $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
- $1,851.00 / $7,307.00 / $13,541.98
| Facility | | $1,851.00 | $7,307.00 | $13,541.98 |