- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.35 / $2,899.38 / $6,546.00
| Facility | | $561.35 | $2,899.38 | $6,546.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,516.71 / $7,645.96 / $11,072.79
| Facility | | $3,516.71 | $7,645.96 | $11,072.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.22 / $4,513.39 / $4,513.39
| Facility | | $321.22 | $4,513.39 | $4,513.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.46 / $901.00 / $3,963.12
| Facility | | $392.46 | $901.00 | $3,963.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $38.74 / $38.74 / $38.74
| Facility | AS | $38.74 | $38.74 | $38.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,959.00
| Facility | | $1,141.00 | $4,717.00 | $10,959.00 |