- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,039.00 / $8,229.00
| Facility | | $860.00 | $2,039.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,062.90 / $9,565.00 / $21,322.13
| Facility | | $7,062.90 | $9,565.00 | $21,322.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.44 / $2,595.10 / $2,993.62
| Facility | | $1,898.44 | $2,595.10 | $2,993.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,069.48 / $2,287.73 / $2,287.73
| Facility | | $2,069.48 | $2,287.73 | $2,287.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $224.74 / $224.74 / $224.74
| Facility | AS | $224.74 | $224.74 | $224.74 |
- 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 |