- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,728.00 / $14,100.00
| Facility | | $1,346.00 | $4,728.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,175.22 / $6,585.53 / $10,443.50
| Facility | | $4,175.22 | $6,585.53 | $10,443.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.90 / $1,475.40 / $7,584.00
| Facility | | $1,008.90 | $1,475.40 | $7,584.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,568.44 / $1,568.44 / $1,568.44
| Facility | AS | $1,568.44 | $1,568.44 | $1,568.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,624.00 / $5,264.55 / $8,753.15
| Facility | | $1,624.00 | $5,264.55 | $8,753.15 |