- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,973.59 / $5,432.00
| Facility | | $900.00 | $2,973.59 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,766.52 / $9,489.54 / $18,151.81
| Facility | | $4,766.52 | $9,489.54 | $18,151.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,616.48 / $1,706.71 / $1,706.71
| Facility | | $1,616.48 | $1,706.71 | $1,706.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $2,052.10
| Facility | | $488.00 | $675.00 | $2,052.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $200.73 / $200.73 / $200.73
| Facility | AS | $200.73 | $200.73 | $200.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,309.00 / $7,168.00
| Facility | | $385.00 | $1,309.00 | $7,168.00 |