- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.33 / $8,002.00 / $10,561.00
| Facility | | $1,373.33 | $8,002.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.67 / $1,062.64 / $2,160.11
| Facility | | $865.67 | $1,062.64 | $2,160.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.13 / $148.77 / $302.42
| Facility | AS | $140.13 | $148.77 | $302.42 |
- 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
- $4,962.60 / $16,223.75 / $26,542.00
| Facility | | $4,962.60 | $16,223.75 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $195.51 / $1,537.78 / $1,537.78
| Facility | AS | $195.51 | $1,537.78 | $1,537.78 |