- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,803.00 / $12,600.00
| Facility | | $1,048.00 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,891.84 / $3,005.44 / $4,748.57
| Facility | | $1,891.84 | $3,005.44 | $4,748.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.60 / $1,937.60 / $1,937.60
| Facility | | $1,937.60 | $1,937.60 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.83 / $1,048.47 / $5,847.50
| Facility | | $733.83 | $1,048.47 | $5,847.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $185.88 / $646.16 / $646.16
| Facility | AS | $185.88 | $646.16 | $646.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |