- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $5,888.44 / $10,000.00
| Facility | | $512.86 | $5,888.44 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $11,220.18 / $26,302.68
| Facility | | $3,019.95 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $4,365.16
| Facility | | $1,318.26 | $1,862.09 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Facility | AS | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $3,467.37
| Facility | | $1,412.54 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,548.82 / $12,022.64
| Facility | | $512.86 | $1,548.82 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,000.00 / $15,135.61
| Facility | | $5,888.44 | $10,000.00 | $15,135.61 |