- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,915.00 / $14,100.00
| Facility | | $1,456.00 | $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
- $1,329.98 / $1,870.72 / $8,085.52
| Facility | | $1,329.98 | $1,870.72 | $8,085.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $339.92 / $615.52 / $615.52
| Facility | AS | $339.92 | $615.52 | $615.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,910.00 / $9,232.95
| Facility | | $1,481.00 | $5,910.00 | $9,232.95 |