- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.52 / $4,761.00 / $9,676.00
| Facility | | $1,437.52 | $4,761.00 | $9,676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $9,830.00 / $19,406.00
| Facility | | $6,996.00 | $9,830.00 | $19,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.00 / $3,851.90 / $5,577.46
| Facility | | $2,211.00 | $3,851.90 | $5,577.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.11 / $140.11 / $140.11
| Facility | AS | $140.11 | $140.11 | $140.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,499.00 / $14,242.22
| Facility | | $3,028.00 | $7,499.00 | $14,242.22 |