- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.00 / $3,478.00 / $7,602.00
| Facility | | $1,256.00 | $3,478.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,387.00 / $4,235.00
| Facility | | $1,375.00 | $2,387.00 | $4,235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,065.64 / $6,240.78
| Facility | | $55.00 | $6,065.64 | $6,240.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.04 / $376.31 / $376.31
| Facility | AS | $193.04 | $376.31 | $376.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $5,728.00 / $10,111.00
| Facility | | $2,799.00 | $5,728.00 | $10,111.00 |