- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $2,009.71 / $7,439.00
| Facility | | $1,615.00 | $2,009.71 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $13,652.00
| Facility | | $606.10 | $606.10 | $13,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.71 / $2,489.35 / $3,990.67
| Facility | | $2,009.71 | $2,489.35 | $3,990.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $309.54 / $348.51 / $635.87
| Facility | AS | $309.54 | $348.51 | $635.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.00 / $3,994.00 / $6,543.00
| Facility | | $806.00 | $3,994.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $25,724.60 / $25,724.60
| Facility | | $5,000.00 | $25,724.60 | $25,724.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $287.04 / $497.05 / $1,001.40
| Facility | AS | $287.04 | $497.05 | $1,001.40 |