- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $4,826.00 / $14,100.00
| Facility | | $1,392.00 | $4,826.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,568.70 / $10,382.21 / $16,531.03
| Facility | | $6,568.70 | $10,382.21 | $16,531.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.86 / $1,743.82 / $8,753.15
| Facility | | $1,121.86 | $1,743.82 | $8,753.15 |
- 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
- $1,280.00 / $5,524.00 / $9,232.95
| Facility | | $1,280.00 | $5,524.00 | $9,232.95 |