- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.00 / $3,214.00 / $8,000.00
| Facility | | $1,098.00 | $3,214.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $14,717.03
| Facility | | $2,224.00 | $4,490.00 | $14,717.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.02 / $906.78 / $4,237.31
| Facility | | $526.02 | $906.78 | $4,237.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.34 / $165.34 / $298.37
| Facility | AS | $165.34 | $165.34 | $298.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $10,781.00
| Facility | | $2,156.00 | $4,000.00 | $10,781.00 |