- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $5,511.00 / $16,900.00
| Facility | | $1,392.00 | $5,511.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,951.01 / $9,242.51 / $14,465.62
| Facility | | $5,951.01 | $9,242.51 | $14,465.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.71 / $1,415.59 / $5,415.32
| Facility | | $1,002.71 | $1,415.59 | $5,415.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $497.90 / $497.90 / $497.90
| Facility | AS | $497.90 | $497.90 | $497.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |