- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $6,284.00 / $13,151.00
| Facility | | $1,760.00 | $6,284.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,587.00 / $17,951.00
| Facility | | $2,224.00 | $4,587.00 | $17,951.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,023.20 / $7,500.00
| Facility | | $55.00 | $1,023.20 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.81 / $195.28 / $195.28
| Facility | AS | $103.81 | $195.28 | $195.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |