- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,630.27 / $6,606.93
| Facility | | $1,000.00 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,511.38 / $14,125.38
| Facility | | $5,495.41 | $8,511.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $120.23 / $1,584.89
| Facility | | $77.62 | $120.23 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $38.02 / $38.02 / $38.02
| Facility | AS | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $707.95 / $1,659.59
| Facility | | $138.04 | $707.95 | $1,659.59 |