- 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
- $6,271.00 / $9,962.39 / $15,740.47
| Facility | | $6,271.00 | $9,962.39 | $15,740.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.91 / $153.12 / $2,542.00
| Facility | | $106.91 | $153.12 | $2,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $25.65 / $46.47 / $46.47
| Facility | AS | $25.65 | $46.47 | $46.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.00 / $634.00 / $1,883.00
| Facility | | $139.00 | $634.00 | $1,883.00 |