- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,497.74 / $4,100.00 / $8,622.00
| Facility | | $1,497.74 | $4,100.00 | $8,622.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $10,250.00 / $23,778.77
| Facility | | $4,977.00 | $10,250.00 | $23,778.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,401.97 / $2,472.40 / $14,936.13
| Facility | | $1,401.97 | $2,472.40 | $14,936.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $139.02 / $139.02 / $139.02
| Facility | AS | $139.02 | $139.02 | $139.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |