- 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
- $5,951.01 / $9,242.51 / $14,465.62
| Facility | | $5,951.01 | $9,242.51 | $14,465.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.38 / $1,969.01 / $5,708.09
| Facility | | $1,347.38 | $1,969.01 | $5,708.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $720.28 / $720.28 / $720.28
| Facility | AS | $720.28 | $720.28 | $720.28 |
- 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 |