- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.50 / $1,152.70 / $8,229.00
| Facility | | $902.50 | $1,152.70 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $9,122.94 / $15,243.15
| Facility | | $5,049.25 | $9,122.94 | $15,243.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.76 / $1,215.75 / $1,402.45
| Facility | | $885.76 | $1,215.75 | $1,402.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.83 / $1,066.83 / $1,066.83
| Facility | | $1,066.83 | $1,066.83 | $1,066.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.84 / $104.84 / $104.84
| Facility | AS | $104.84 | $104.84 | $104.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |