- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,656.00 / $16,900.00
| Facility | | $1,456.00 | $5,656.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.12 / $11,671.64 / $18,341.14
| Facility | | $7,516.12 | $11,671.64 | $18,341.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.21 / $1,481.00 / $10,198.00
| Facility | | $904.21 | $1,481.00 | $10,198.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,196.53 / $1,196.53 / $1,196.53
| Facility | AS | $1,196.53 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,407.00 / $9,232.95
| Facility | | $1,481.00 | $5,407.00 | $9,232.95 |