- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $5,389.00 / $9,823.00
| Facility | | $1,760.00 | $5,389.00 | $9,823.00 |
- 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
- $763.57 / $1,247.09 / $21,310.46
| Facility | | $763.57 | $1,247.09 | $21,310.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $209.68 / $209.68 / $2,392.36
| Facility | AS | $209.68 | $209.68 | $2,392.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,347.00 / $6,854.00
| Facility | | $1,748.00 | $3,347.00 | $6,854.00 |