- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.00 / $4,641.84 / $9,823.00
| Facility | | $1,704.00 | $4,641.84 | $9,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.45 / $775.97 / $4,553.00
| Facility | | $408.45 | $775.97 | $4,553.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $135.53 / $1,196.53 / $1,196.53
| Facility | AS | $135.53 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $6,944.00
| Facility | | $1,748.00 | $3,502.00 | $6,944.00 |