- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $4,261.00 / $8,000.00
| Facility | | $1,258.00 | $4,261.00 | $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
- $603.17 / $1,102.41 / $3,532.00
| Facility | | $603.17 | $1,102.41 | $3,532.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.87 / $174.87 / $324.41
| Facility | AS | $174.87 | $174.87 | $324.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,849.00 / $5,620.00
| Facility | | $1,644.00 | $2,849.00 | $5,620.00 |