- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.00 / $3,683.00 / $12,600.00
| Facility | | $957.00 | $3,683.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,164.27 / $6,581.89 / $10,479.96
| Facility | | $4,164.27 | $6,581.89 | $10,479.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.11 / $355.43 / $2,562.00
| Facility | | $222.11 | $355.43 | $2,562.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.84 / $108.84 / $108.84
| Facility | AS | $108.84 | $108.84 | $108.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $610.00 / $1,883.00
| Facility | | $100.00 | $610.00 | $1,883.00 |