- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,273.04 / $3,650.00 / $9,775.00
| Facility | | $1,273.04 | $3,650.00 | $9,775.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.21 / $8,766.98 / $14,405.53
| Facility | | $4,636.21 | $8,766.98 | $14,405.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.21 / $1,271.21 / $3,377.18
| Facility | | $1,271.21 | $1,271.21 | $3,377.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.40 / $123.40 / $123.40
| Facility | AS | $123.40 | $123.40 | $123.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |