- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.48 / $2,139.54 / $10,561.00
| Facility | | $877.48 | $2,139.54 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,221.47 / $3,221.47 / $4,603.08
| Facility | | $3,221.47 | $3,221.47 | $4,603.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $15,276.20
| Facility | | $748.70 | $748.70 | $15,276.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.48 / $1,230.00 / $1,782.20
| Facility | | $877.48 | $1,230.00 | $1,782.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $152.74 / $212.97 / $277.63
| Facility | AS | $152.74 | $212.97 | $277.63 |
- 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
- $4,205.75 / $44,065.11 / $50,485.10
| Facility | | $4,205.75 | $44,065.11 | $50,485.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.36 / $2,876.95 / $4,785.27
| Facility | AS | $204.36 | $2,876.95 | $4,785.27 |