- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,067.01 / $8,229.00
| Facility | | $860.00 | $2,067.01 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,584.00 / $10,990.10 / $30,856.09
| Facility | | $8,584.00 | $10,990.10 | $30,856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,948.16 / $2,630.74 / $3,034.76
| Facility | | $1,948.16 | $2,630.74 | $3,034.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.17 / $2,304.17 / $2,609.21
| Facility | | $2,304.17 | $2,304.17 | $2,609.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $228.32 / $228.32 / $228.32
| Facility | AS | $228.32 | $228.32 | $228.32 |
- 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 |