- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,150.16 / $8,229.00
| Facility | | $860.00 | $2,150.16 | $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
- $1,823.22 / $2,736.57 / $3,156.83
| Facility | | $1,823.22 | $2,736.57 | $3,156.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,408.56 / $2,408.56 / $2,714.28
| Facility | | $2,408.56 | $2,408.56 | $2,714.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $238.75 / $238.75 / $238.75
| Facility | AS | $238.75 | $238.75 | $238.75 |
- 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 |