- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $3,907.00 / $8,000.00
| Facility | | $1,110.00 | $3,907.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,958.00
| Facility | | $821.00 | $1,963.00 | $4,958.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.32 / $2,361.54 / $26,542.00
| Facility | | $1,006.32 | $2,361.54 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $298.26 / $298.26 / $1,442.13
| Facility | AS | $298.26 | $298.26 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $10,781.00
| Facility | | $2,156.00 | $4,000.00 | $10,781.00 |