- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,344.17 / $8,229.00
| Facility | | $860.00 | $2,344.17 | $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
- $2,012.37 / $2,983.50 / $3,441.68
| Facility | | $2,012.37 | $2,983.50 | $3,441.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,606.76 / $2,606.76 / $2,606.76
| Facility | | $2,606.76 | $2,606.76 | $2,606.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.88 / $257.88 / $257.88
| Facility | AS | $257.88 | $257.88 | $257.88 |
- 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 |