- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,020.54 / $8,229.00
| Facility | | $860.00 | $2,020.54 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,503.33 / $8,650.50 / $13,595.06
| Facility | | $4,503.33 | $8,650.50 | $13,595.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,555.40 / $2,134.87 / $2,462.71
| Facility | | $1,555.40 | $2,134.87 | $2,462.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,881.48 / $1,881.48 / $2,411.13
| Facility | | $1,881.48 | $1,881.48 | $2,411.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.09 / $182.09 / $182.09
| Facility | AS | $182.09 | $182.09 | $182.09 |
- 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 |