- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,684.00 / $18,600.00
| Facility | | $1,346.00 | $3,684.00 | $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 / $2,579.10 / $5,991.35
| Facility | | $773.00 | $2,579.10 | $5,991.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,054.68 / $1,054.68 / $1,054.68
| Facility | AS | $1,054.68 | $1,054.68 | $1,054.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |