- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.38 / $5,609.20 / $10,690.00
| Facility | | $668.38 | $5,609.20 | $10,690.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,790.43 / $5,790.43 / $5,874.92
| Facility | | $5,790.43 | $5,790.43 | $5,874.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $16,473.58
| Facility | | $852.10 | $852.10 | $16,473.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.38 / $834.00 / $1,376.79
| Facility | | $668.38 | $834.00 | $1,376.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $116.33 / $116.76 / $211.48
| Facility | AS | $116.33 | $116.76 | $211.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,153.00 / $21,463.00 / $29,047.00
| Facility | | $8,153.00 | $21,463.00 | $29,047.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,214.25 / $47,519.02 / $54,442.25
| Facility | | $3,214.25 | $47,519.02 | $54,442.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $156.77 / $3,102.45 / $5,160.35
| Facility | AS | $156.77 | $3,102.45 | $5,160.35 |