- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,946.00 / $16,900.00
| Facility | | $1,456.00 | $5,946.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,481.18 / $14,723.14 / $23,136.37
| Facility | | $9,481.18 | $14,723.14 | $23,136.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.64 / $1,563.74 / $8,804.00
| Facility | | $1,006.64 | $1,563.74 | $8,804.00 |
- 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
- $1,481.00 / $5,524.00 / $9,232.95
| Facility | | $1,481.00 | $5,524.00 | $9,232.95 |