- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.57 / $5,866.00 / $16,467.00
| Facility | | $556.57 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.39 / $5,205.85 / $8,705.65
| Facility | | $2,347.39 | $5,205.85 | $8,705.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $555.37 / $2,581.96
| Facility | | $505.00 | $555.37 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.10 / $55.10 / $55.10
| Facility | AS | $55.10 | $55.10 | $55.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $640.05 / $1,053.88
| Facility | | $507.00 | $640.05 | $1,053.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.88 / $92.68 / $141.43
| Facility | AS | $75.88 | $92.68 | $141.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |