- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.27 / $1,245.00 / $8,413.00
| Facility | | $642.27 | $1,245.00 | $8,413.00 |
- 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
- $642.27 / $860.00 / $1,308.58
| Facility | | $642.27 | $860.00 | $1,308.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.93 / $134.26 / $203.21
| Facility | AS | $110.93 | $134.26 | $203.21 |
- 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
- $3,097.05 / $19,913.50 / $26,542.00
| Facility | | $3,097.05 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $150.63 / $1,134.79 / $1,887.52
| Facility | AS | $150.63 | $1,134.79 | $1,887.52 |