- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,742.00 / $18,600.00
| Facility | | $1,346.00 | $3,742.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $900.00
| Facility | | $900.00 | $900.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.00 / $2,548.54 / $5,882.00
| Facility | | $1,160.00 | $2,548.54 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $559.38 / $1,057.84 / $1,057.84
| Facility | AS | $559.38 | $1,057.84 | $1,057.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $2,654.00 / $6,272.82
| Facility | | $498.00 | $2,654.00 | $6,272.82 |