- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.18 / $2,738.01 / $16,467.00
| Facility | | $1,179.18 | $2,738.01 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.55 / $111.55 / $111.55
| Facility | AS | $111.55 | $111.55 | $111.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.67 / $1,259.44 / $2,028.08
| Facility | | $1,028.67 | $1,259.44 | $2,028.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.19 / $172.88 / $263.80
| Facility | AS | $158.19 | $172.88 | $263.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |