- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.79 / $3,500.00 / $15,057.58
| Facility | | $860.79 | $3,500.00 | $15,057.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,542.72 / $9,001.82 / $13,048.12
| Facility | | $4,542.72 | $9,001.82 | $13,048.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.51 / $5,636.13 / $5,636.13
| Facility | | $563.51 | $5,636.13 | $5,636.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.68 / $901.00 / $1,141.00
| Facility | | $686.68 | $901.00 | $1,141.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.78 / $67.78 / $67.78
| Facility | AS | $67.78 | $67.78 | $67.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $12,805.00
| Facility | | $1,200.00 | $5,780.00 | $12,805.00 |