- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.26 / $3,684.00 / $18,600.00
| Facility | | $1,006.26 | $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 / $1,537.55 / $5,882.00
| Facility | | $773.00 | $1,537.55 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $531.50 / $531.50 / $531.50
| Facility | AS | $531.50 | $531.50 | $531.50 |
- 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 |