- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $991.00 / $1,618.74 / $7,702.00
| Facility | | $991.00 | $1,618.74 | $7,702.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,559.00 / $18,409.41 / $55,575.98
| Facility | | $6,559.00 | $18,409.41 | $55,575.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.66 / $1,998.78 / $2,305.75
| Facility | | $1,353.66 | $1,998.78 | $2,305.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.94 / $1,753.40 / $1,753.40
| Facility | | $1,593.94 | $1,753.40 | $1,753.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.63 / $174.63 / $174.63
| Facility | AS | $174.63 | $174.63 | $174.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |