- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.00 / $2,155.60 / $10,152.00
| Facility | | $896.00 | $2,155.60 | $10,152.00 |
- 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
- $1,060.80 / $1,455.78 / $1,679.33
| Facility | | $1,060.80 | $1,455.78 | $1,679.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.86 / $1,277.86 / $1,338.41
| Facility | | $1,277.86 | $1,277.86 | $1,338.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.67 / $124.67 / $124.67
| Facility | AS | $124.67 | $124.67 | $124.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,069.00
| Facility | | $842.00 | $4,539.00 | $10,069.00 |