- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,803.00 / $12,600.00
| Facility | | $1,150.00 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,794.37 / $6,027.89 / $9,524.00
| Facility | | $3,794.37 | $6,027.89 | $9,524.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,491.09 / $1,491.09 / $1,491.09
| Facility | | $1,491.09 | $1,491.09 | $1,491.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.78 / $772.24 / $5,543.93
| Facility | | $458.78 | $772.24 | $5,543.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.75 / $497.27 / $497.27
| Facility | AS | $131.75 | $497.27 | $497.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |