- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.00 / $3,214.00 / $8,000.00
| Facility | | $1,098.00 | $3,214.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.75 / $852.31 / $16,394.00
| Facility | | $525.75 | $852.31 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $145.82 / $145.82 / $1,887.52
| Facility | AS | $145.82 | $145.82 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $6,854.00
| Facility | | $1,748.00 | $3,502.00 | $6,854.00 |