- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.00 / $4,387.00 / $8,763.29
| Facility | | $1,230.00 | $4,387.00 | $8,763.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,984.50 / $9,620.00 / $16,096.49
| Facility | | $4,984.50 | $9,620.00 | $16,096.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.40 / $6,775.76 / $9,672.39
| Facility | | $2,266.40 | $6,775.76 | $9,672.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.27 / $108.27 / $108.27
| Facility | AS | $108.27 | $108.27 | $108.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,500.00 / $9,300.00
| Facility | | $1,292.00 | $3,500.00 | $9,300.00 |