- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.25 / $4,300.38 / $10,924.00
| Facility | | $585.25 | $4,300.38 | $10,924.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,094.75 / $2,094.75 / $2,993.14
| Facility | | $2,094.75 | $2,094.75 | $2,993.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.71 / $912.00 / $1,595.00
| Facility | | $607.71 | $912.00 | $1,595.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.04 / $156.44 / $223.30
| Facility | AS | $112.04 | $156.44 | $223.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $8,549.00 / $13,997.00
| Facility | | $2,629.00 | $8,549.00 | $13,997.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.84 / $8,957.00 / $26,542.00
| Facility | | $2,691.84 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.10 / $510.42 / $849.00
| Facility | AS | $165.10 | $510.42 | $849.00 |