- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,683.00 / $18,600.00
| Facility | | $1,346.00 | $3,683.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,211.26 / $14,558.95 / $23,181.40
| Facility | | $9,211.26 | $14,558.95 | $23,181.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $2,623.92 / $5,991.35
| Facility | | $773.00 | $2,623.92 | $5,991.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,020.61 / $1,020.61 / $1,020.61
| Facility | AS | $1,020.61 | $1,020.61 | $1,020.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $2,594.00 / $6,155.68
| Facility | | $498.00 | $2,594.00 | $6,155.68 |