- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,683.00 / $7,500.00
| Facility | | $882.00 | $3,683.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,508.22 / $19,762.84
| Facility | | $7,873.50 | $12,508.22 | $19,762.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.56 / $402.91 / $2,000.00
| Facility | | $279.56 | $402.91 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.90 / $128.52 / $128.52
| Facility | AS | $66.90 | $128.52 | $128.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.00 / $634.00 / $1,883.00
| Facility | | $139.00 | $634.00 | $1,883.00 |