- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $823.71 / $1,245.00 / $10,561.00
| Facility | | $823.71 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $6,025.59
| Facility | | $748.70 | $748.70 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $823.71 / $1,049.08 / $1,685.15
| Facility | | $823.71 | $1,049.08 | $1,685.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.16 / $163.94 / $260.62
| Facility | AS | $118.16 | $163.94 | $260.62 |
- 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
- $3,101.80 / $19,913.50 / $26,542.00
| Facility | | $3,101.80 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.64 / $1,134.79 / $1,887.52
| Facility | AS | $191.64 | $1,134.79 | $1,887.52 |