- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,830.58 / $8,229.00
| Facility | | $860.00 | $1,830.58 | $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
- $1,559.48 / $2,329.82 / $2,687.63
| Facility | | $1,559.48 | $2,329.82 | $2,687.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.60 / $2,047.60 / $2,277.83
| Facility | | $2,047.60 | $2,047.60 | $2,277.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.96 / $202.96 / $202.96
| Facility | AS | $202.96 | $202.96 | $202.96 |
- 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 |