- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $4,610.00 / $12,154.00
| Facility | | $1,547.00 | $4,610.00 | $12,154.00 |
- 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
- $767.92 / $1,260.38 / $19,913.50
| Facility | | $767.92 | $1,260.38 | $19,913.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $212.63 / $212.63 / $1,887.52
| Facility | AS | $212.63 | $212.63 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,062.56 / $4,000.00 / $10,781.00
| Facility | | $2,062.56 | $4,000.00 | $10,781.00 |