- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.16 / $1,615.00 / $10,561.00
| Facility | | $816.16 | $1,615.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $796.94 / $1,555.70
| Facility | | $450.00 | $796.94 | $1,555.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.00 / $76.34 / $270.87
| Facility | AS | $63.00 | $76.34 | $270.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,366.00 / $9,541.00 / $14,589.00
| Facility | | $3,366.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,406.52 / $7,984.00
| Facility | | $55.00 | $5,406.52 | $7,984.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.81 / $202.83 / $757.42
| Facility | AS | $184.81 | $202.83 | $757.42 |