- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.00 / $4,856.00 / $14,100.00
| Facility | | $1,474.00 | $4,856.00 | $14,100.00 |
- 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
- $1,465.19 / $2,008.55 / $10,232.00
| Facility | | $1,465.19 | $2,008.55 | $10,232.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $373.61 / $676.22 / $676.22
| Facility | AS | $373.61 | $676.22 | $676.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.00 / $8,707.00 / $14,587.03
| Facility | | $1,940.00 | $8,707.00 | $14,587.03 |