- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.34 / $2,901.05 / $16,467.00
| Facility | | $958.34 | $2,901.05 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,435.81 / $5,095.07 / $8,656.54
| Facility | | $2,435.81 | $5,095.07 | $8,656.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $2,581.96
| Facility | | $580.00 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.76 / $142.76 / $142.76
| Facility | AS | $142.76 | $142.76 | $142.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.54 / $1,243.09 / $2,056.01
| Facility | | $949.54 | $1,243.09 | $2,056.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $149.31 / $176.68 / $299.49
| Facility | AS | $149.31 | $176.68 | $299.49 |
- 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 |