- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.03 / $3,677.85 / $10,924.00
| Facility | | $717.03 | $3,677.85 | $10,924.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,397.92 / $4,397.92 / $6,284.08
| Facility | | $4,397.92 | $4,397.92 | $6,284.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $17,027.56
| Facility | | $748.70 | $748.70 | $17,027.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.03 / $981.00 / $1,465.56
| Facility | | $717.03 | $981.00 | $1,465.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.60 / $137.34 / $226.87
| Facility | AS | $124.60 | $137.34 | $226.87 |
- 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
- $3,453.70 / $49,117.01 / $56,273.05
| Facility | | $3,453.70 | $49,117.01 | $56,273.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $168.35 / $3,206.78 / $5,333.89
| Facility | AS | $168.35 | $3,206.78 | $5,333.89 |