- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,350.00 / $13,200.00
| Facility | | $1,346.00 | $4,350.00 | $13,200.00 |
- 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
- $900.00 / $900.00 / $900.00
| Facility | | $900.00 | $900.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.58 / $1,417.24 / $7,741.00
| Facility | | $1,017.58 | $1,417.24 | $7,741.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.71 / $445.36 / $445.36
| Facility | AS | $245.71 | $445.36 | $445.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,910.00 / $9,232.95
| Facility | | $1,481.00 | $5,910.00 | $9,232.95 |