- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.00 / $5,655.00 / $10,746.00
| Facility | | $1,391.00 | $5,655.00 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,467.00 / $9,272.00
| Facility | | $2,430.00 | $5,467.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,897.00 / $16,223.75 / $16,223.75
| Facility | | $5,897.00 | $16,223.75 | $16,223.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $230.52 / $1,537.78 / $1,537.78
| Facility | AS | $230.52 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |