- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.84 / $1,245.00 / $10,561.00
| Facility | | $702.84 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,552.83 / $2,552.83 / $2,590.07
| Facility | | $2,552.83 | $2,552.83 | $2,590.07 |
- 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
- $702.84 / $933.09 / $1,458.90
| Facility | | $702.84 | $933.09 | $1,458.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $121.94 / $140.97 / $222.38
| Facility | AS | $121.94 | $140.97 | $222.38 |
- 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
- $55.00 / $7,817.95 / $8,957.00
| Facility | | $55.00 | $7,817.95 | $8,957.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.50 / $510.42 / $849.00
| Facility | AS | $165.50 | $510.42 | $849.00 |