- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.23 / $1,572.02 / $7,807.05
| Facility | | $947.23 | $1,572.02 | $7,807.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.23 / $1,314.89 / $2,317.60
| Facility | | $947.23 | $1,314.89 | $2,317.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.75 / $184.08 / $309.37
| Facility | AS | $151.75 | $184.08 | $309.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,688.00 / $15,545.00 / $22,780.00
| Facility | | $6,688.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,178.13 / $13,856.55
| Facility | | $55.00 | $6,178.13 | $13,856.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $212.07 / $230.98 / $1,314.53
| Facility | AS | $212.07 | $230.98 | $1,314.53 |