- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.00 / $3,214.00 / $7,365.00
| Facility | | $1,098.00 | $3,214.00 | $7,365.00 |
- 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
- $576.42 / $953.84 / $16,394.00
| Facility | | $576.42 | $953.84 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.81 / $158.81 / $1,887.52
| Facility | AS | $158.81 | $158.81 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,829.00 / $3,700.00 / $23,874.12
| Facility | | $1,829.00 | $3,700.00 | $23,874.12 |