- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.89 / $3,684.00 / $18,600.00
| Facility | | $1,103.89 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,343.17 / $11,606.33 / $18,480.11
| Facility | | $7,343.17 | $11,606.33 | $18,480.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,258.79 / $5,882.00
| Facility | | $773.00 | $1,258.79 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $381.03 / $381.03 / $381.03
| Facility | AS | $381.03 | $381.03 | $381.03 |
- 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 |