- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.50 / $9,000.00 / $20,928.72
| Facility | | $556.50 | $9,000.00 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.18 / $740.51 / $2,003.24
| Facility | | $467.18 | $740.51 | $2,003.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.49 / $196.49 / $196.49
| Facility | AS | $196.49 | $196.49 | $196.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.69 / $1,327.50 / $2,842.49
| Facility | | $944.69 | $1,327.50 | $2,842.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |