- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.55 / $2,737.10 / $7,968.00
| Facility | | $561.55 | $2,737.10 | $7,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,849.86 / $3,849.86 / $3,906.03
| Facility | | $3,849.86 | $3,849.86 | $3,906.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,838.94
| Facility | | $606.10 | $606.10 | $7,838.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.55 / $776.96 / $1,124.09
| Facility | | $561.55 | $776.96 | $1,124.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.07 / $142.66 / $177.68
| Facility | AS | $97.07 | $142.66 | $177.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,238.68 / $25,906.30 / $26,542.00
| Facility | | $3,238.68 | $25,906.30 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.85 / $1,476.30 / $2,455.55
| Facility | AS | $131.85 | $1,476.30 | $2,455.55 |