- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.00 / $5,915.00 / $14,100.00
| Facility | | $1,515.00 | $5,915.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,508.22 / $19,762.84
| Facility | | $7,873.50 | $12,508.22 | $19,762.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $900.00
| Facility | | $900.00 | $900.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.29 / $2,303.13 / $8,085.52
| Facility | | $1,517.29 | $2,303.13 | $8,085.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.83 / $756.76 / $756.76
| Facility | AS | $416.83 | $756.76 | $756.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.70 / $5,258.72 / $9,232.95
| Facility | | $1,172.70 | $5,258.72 | $9,232.95 |