- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,686.16 / $14,100.00
| Facility | | $1,456.00 | $5,686.16 | $14,100.00 |
- 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
- $952.53 / $1,472.13 / $8,509.00
| Facility | | $952.53 | $1,472.13 | $8,509.00 |
- 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
- $1,157.00 / $3,858.00 / $7,077.94
| Facility | | $1,157.00 | $3,858.00 | $7,077.94 |