- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.13 / $4,112.00 / $13,200.00
| Facility | | $1,253.13 | $4,112.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.62 / $11,257.78 / $17,715.63
| Facility | | $7,221.62 | $11,257.78 | $17,715.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.66 / $1,452.87 / $14,139.00
| Facility | | $846.66 | $1,452.87 | $14,139.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,537.78 / $1,537.78 / $1,537.78
| Facility | AS | $1,537.78 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,871.00 / $13,541.98
| Facility | | $1,851.00 | $6,871.00 | $13,541.98 |