- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,213.30 / $8,229.00
| Facility | | $860.00 | $2,213.30 | $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
- $2,125.27 / $2,869.89 / $3,310.62
| Facility | | $2,125.27 | $2,869.89 | $3,310.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.85 / $2,520.85 / $2,735.39
| Facility | | $2,520.85 | $2,520.85 | $2,735.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $250.20 / $250.20 / $250.20
| Facility | AS | $250.20 | $250.20 | $250.20 |
- 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 |