- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.79 / $1,850.00 / $3,884.00
| Facility | | $581.79 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,588.66 / $8,416.15 / $12,057.15
| Facility | | $3,588.66 | $8,416.15 | $12,057.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.16 / $4,810.92 / $4,810.92
| Facility | | $362.16 | $4,810.92 | $4,810.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.24 / $731.00 / $4,042.13
| Facility | | $473.24 | $731.00 | $4,042.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $47.01 / $47.01 / $47.01
| Facility | AS | $47.01 | $47.01 | $47.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $4,717.00 / $10,959.00
| Facility | | $1,100.00 | $4,717.00 | $10,959.00 |