- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,728.00 / $14,100.00
| Facility | | $1,346.00 | $4,728.00 | $14,100.00 |
- 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
- $1,035.47 / $1,400.10 / $5,413.00
| Facility | | $1,035.47 | $1,400.10 | $5,413.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $515.76 / $515.76 / $515.76
| Facility | AS | $515.76 | $515.76 | $515.76 |
- 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 |