- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.48 / $5,946.00 / $16,900.00
| Facility | | $1,319.48 | $5,946.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,334.45 / $14,725.20 / $23,429.85
| Facility | | $9,334.45 | $14,725.20 | $23,429.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.71 / $1,696.20 / $12,300.92
| Facility | | $953.71 | $1,696.20 | $12,300.92 |
- 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 |