- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.04 / $1,338.00 / $10,924.00
| Facility | | $630.04 | $1,338.00 | $10,924.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.04 / $887.71 / $1,344.45
| Facility | | $630.04 | $887.71 | $1,344.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.48 / $125.72 / $199.34
| Facility | AS | $110.48 | $125.72 | $199.34 |
- 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
- $2,432.12 / $8,957.00 / $26,542.00
| Facility | | $2,432.12 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $148.82 / $510.42 / $849.00
| Facility | AS | $148.82 | $510.42 | $849.00 |