- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.06 / $2,671.00 / $4,450.00
| Facility | | $1,080.06 | $2,671.00 | $4,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.72 / $2,800.00 / $8,044.24
| Facility | | $807.72 | $2,800.00 | $8,044.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $273.08 / $533.10 / $533.10
| Facility | AS | $273.08 | $533.10 | $533.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,718.18 / $6,679.00
| Facility | | $300.00 | $1,718.18 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,800.00 / $9,846.08
| Facility | | $822.00 | $2,800.00 | $9,846.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $273.08 / $533.10 / $533.10
| Facility | AS | $273.08 | $533.10 | $533.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,733.00 / $4,256.00
| Facility | | $822.00 | $2,733.00 | $4,256.00 |