- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.90 / $1,167.22 / $8,413.00
| Facility | | $660.90 | $1,167.22 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $8,240.81
| Facility | | $606.10 | $606.10 | $8,240.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.90 / $1,078.71 / $1,694.10
| Facility | | $660.90 | $1,078.71 | $1,694.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $121.83 / $202.16 / $223.86
| Facility | AS | $121.83 | $202.16 | $223.86 |
- 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
- $3,205.20 / $26,542.00 / $27,234.40
| Facility | | $3,205.20 | $26,542.00 | $27,234.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $156.49 / $1,551.98 / $2,581.44
| Facility | AS | $156.49 | $1,551.98 | $2,581.44 |