- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,819.70 / $2,089.30
| Facility | | $1,000.00 | $1,819.70 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,471.29 / $15,488.17
| Facility | | $5,754.40 | $10,471.29 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $1,023.29
| Facility | | $380.19 | $512.86 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | AS | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,585.78 / $10,964.78
| Facility | | $3,981.07 | $7,585.78 | $10,964.78 |