- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.68 / $3,790.67 / $16,467.00
| Facility | | $510.68 | $3,790.67 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,230.50 / $6,836.09 / $12,097.16
| Facility | | $3,230.50 | $6,836.09 | $12,097.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.97 / $715.00 / $2,581.96
| Facility | | $512.97 | $715.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $50.85 / $50.85 / $50.85
| Facility | AS | $50.85 | $50.85 | $50.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.43 / $642.05 / $991.35
| Facility | | $504.43 | $642.05 | $991.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.29 / $94.36 / $133.88
| Facility | AS | $77.29 | $94.36 | $133.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |