- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.82 / $3,021.00 / $8,400.00
| Facility | | $858.82 | $3,021.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,409.25 / $10,182.03 / $16,087.50
| Facility | | $6,409.25 | $10,182.03 | $16,087.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,659.86 / $5,659.86 / $5,659.86
| Facility | | $5,659.86 | $5,659.86 | $5,659.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.36 / $950.02 / $9,344.49
| Facility | | $656.36 | $950.02 | $9,344.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $284.14 / $284.14 / $284.14
| Facility | AS | $284.14 | $284.14 | $284.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,871.00 / $14,139.00
| Facility | | $1,851.00 | $6,871.00 | $14,139.00 |