- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.80 / $1,245.00 / $10,561.00
| Facility | | $641.80 | $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
- $641.80 / $852.00 / $1,297.29
| Facility | | $641.80 | $852.00 | $1,297.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.62 / $119.28 / $207.06
| Facility | AS | $110.62 | $119.28 | $207.06 |
- 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
- $3,089.80 / $19,913.50 / $26,542.00
| Facility | | $3,089.80 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $150.59 / $1,134.79 / $1,887.52
| Facility | AS | $150.59 | $1,134.79 | $1,887.52 |