- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $6,071.00 / $12,154.00
| Facility | | $1,547.00 | $6,071.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,654.00 / $10,043.00
| Facility | | $2,224.00 | $4,654.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,125.00 / $10,806.00 / $10,806.00
| Facility | | $3,125.00 | $10,806.00 | $10,806.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.01 / $574.54 / $8,482.00
| Facility | | $347.01 | $574.54 | $8,482.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $93.56 / $1,537.78 / $1,537.78
| Facility | AS | $93.56 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.00 / $4,763.00 / $9,817.00
| Facility | | $2,285.00 | $4,763.00 | $9,817.00 |