- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.17 / $7,052.22 / $11,299.00
| Facility | | $856.17 | $7,052.22 | $11,299.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,972.02
| Facility | | $606.10 | $606.10 | $7,972.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.17 / $1,219.52 / $1,780.07
| Facility | | $856.17 | $1,219.52 | $1,780.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.06 / $177.80 / $270.89
| Facility | AS | $151.06 | $177.80 | $270.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $22,995.80 / $26,346.10
| Facility | | $55.00 | $22,995.80 | $26,346.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.31 / $1,501.36 / $2,497.23
| Facility | AS | $199.31 | $1,501.36 | $2,497.23 |