- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.33 / $1,245.00 / $10,561.00
| Facility | | $493.33 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $6,025.59
| Facility | | $748.70 | $748.70 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.33 / $690.66 / $998.44
| Facility | | $493.33 | $690.66 | $998.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.17 / $120.26 / $156.09
| Facility | AS | $86.17 | $120.26 | $156.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,899.12 / $19,913.50 / $26,542.00
| Facility | | $1,899.12 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $116.36 / $1,134.79 / $1,887.52
| Facility | AS | $116.36 | $1,134.79 | $1,887.52 |