- 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
- $6,401.30 / $9,277.03 / $12,915.18
| Facility | | $6,401.30 | $9,277.03 | $12,915.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.74 / $1,866.88 / $5,043.93
| Facility | | $1,191.74 | $1,866.88 | $5,043.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $638.23 / $638.23 / $638.23
| Facility | AS | $638.23 | $638.23 | $638.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |