- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.94 / $6,016.00 / $14,100.00
| Facility | | $1,529.94 | $6,016.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,565.00 / $9,202.00 / $17,206.00
| Facility | | $3,565.00 | $9,202.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,100.00 / $3,025.00
| Facility | | $900.00 | $1,100.00 | $3,025.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.50 / $120.50 / $120.50
| Facility | AS | $120.50 | $120.50 | $120.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,605.00 / $7,450.00 / $17,416.00
| Facility | | $2,605.00 | $7,450.00 | $17,416.00 |