- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,683.00 / $18,600.00
| Facility | | $1,346.00 | $3,683.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,301.33 / $17,825.49 / $28,268.11
| Facility | | $11,301.33 | $17,825.49 | $28,268.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.27 / $1,760.00 / $5,833.89
| Facility | | $1,222.27 | $1,760.00 | $5,833.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $604.77 / $604.77 / $604.77
| Facility | AS | $604.77 | $604.77 | $604.77 |
- 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 |