- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.58 / $4,230.00 / $9,727.00
| Facility | | $479.58 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.95 / $5,095.07 / $8,656.54
| Facility | | $2,001.95 | $5,095.07 | $8,656.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $714.12 / $2,581.96
| Facility | | $505.00 | $714.12 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $71.41 / $71.41 / $71.41
| Facility | AS | $71.41 | $71.41 | $71.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.58 / $716.98 / $1,148.18
| Facility | | $479.58 | $716.98 | $1,148.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.93 / $118.44 / $157.02
| Facility | AS | $83.93 | $118.44 | $157.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |