- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.12 / $5,724.00 / $8,413.00
| Facility | | $951.12 | $5,724.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,665.09 / $3,665.09 / $3,718.57
| Facility | | $3,665.09 | $3,665.09 | $3,718.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.12 / $1,293.00 / $1,973.10
| Facility | | $951.12 | $1,293.00 | $1,973.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $167.92 / $181.02 / $300.93
| Facility | AS | $167.92 | $181.02 | $300.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,380.50 / $19,913.50 / $26,542.00
| Facility | | $6,380.50 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $220.77 / $1,134.79 / $1,887.52
| Facility | AS | $220.77 | $1,134.79 | $1,887.52 |