- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.93 / $2,678.00 / $7,602.00
| Facility | | $1,252.93 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,331.00 / $8,232.00 / $13,961.00
| Facility | | $4,331.00 | $8,232.00 | $13,961.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,897.00 / $10,662.06 / $10,870.26
| Facility | | $5,897.00 | $10,662.06 | $10,870.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $395.57 / $776.01 / $776.01
| Facility | AS | $395.57 | $776.01 | $776.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $12,443.00
| Facility | | $1,200.00 | $2,665.00 | $12,443.00 |