- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.00 / $3,292.00 / $10,234.00
| Facility | | $1,067.00 | $3,292.00 | $10,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.00 / $5,138.00 / $7,782.00
| Facility | | $2,803.00 | $5,138.00 | $7,782.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $8,768.24 / $9,043.20
| Facility | | $55.00 | $8,768.24 | $9,043.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $244.86 / $478.33 / $478.33
| Facility | AS | $244.86 | $478.33 | $478.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.00 / $4,567.00 / $7,669.00
| Facility | | $2,259.00 | $4,567.00 | $7,669.00 |