- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,630.61 / $8,229.00
| Facility | | $860.00 | $2,630.61 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $8,584.00 / $11,253.00
| Facility | | $4,755.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,558.83 / $3,489.46 / $4,025.34
| Facility | | $2,558.83 | $3,489.46 | $4,025.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.96 / $3,073.31 / $3,073.31
| Facility | | $2,346.96 | $3,073.31 | $3,073.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $299.11 / $299.11 / $299.11
| Facility | AS | $299.11 | $299.11 | $299.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $4,298.00 / $30,001.00
| Facility | | $599.00 | $4,298.00 | $30,001.00 |