- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.03 / $5,621.00 / $9,870.00
| Facility | | $800.03 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,301.68 / $10,798.84 / $19,132.41
| Facility | | $4,301.68 | $10,798.84 | $19,132.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $3,639.40 / $4,676.68
| Facility | | $505.00 | $3,639.40 | $4,676.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.01 / $817.11 / $1,537.35
| Facility | | $657.01 | $817.11 | $1,537.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.96 / $104.02 / $175.63
| Facility | AS | $92.96 | $104.02 | $175.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |