- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $3,684.00 / $18,600.00
| Facility | | $1,300.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,858.92 / $9,241.20 / $14,654.94
| Facility | | $5,858.92 | $9,241.20 | $14,654.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.13 / $1,703.14 / $4,701.46
| Facility | | $1,027.13 | $1,703.14 | $4,701.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $600.67 / $600.67 / $600.67
| Facility | AS | $600.67 | $600.67 | $600.67 |
- 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 |