- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,719.53 / $4,500.00 / $9,367.00
| Facility | | $1,719.53 | $4,500.00 | $9,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,565.00 / $9,458.00 / $17,206.00
| Facility | | $3,565.00 | $9,458.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $956.00 / $2,062.11
| Facility | | $730.00 | $956.00 | $2,062.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.42 / $193.42 / $193.42
| Facility | AS | $193.42 | $193.42 | $193.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,693.00 / $7,326.50
| Facility | | $718.00 | $2,693.00 | $7,326.50 |