- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $983.31 / $3,324.50 / $7,593.00
| Facility | | $983.31 | $3,324.50 | $7,593.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $5,302.65
| Facility | | $530.04 | $530.04 | $5,302.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $983.31 / $1,266.86 / $1,962.45
| Facility | | $983.31 | $1,266.86 | $1,962.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.76 / $177.36 / $311.12
| Facility | AS | $158.76 | $177.36 | $311.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,306.00 / $10,968.00 / $17,120.00
| Facility | | $3,306.00 | $10,968.00 | $17,120.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,630.85 / $16,394.00 / $17,524.30
| Facility | | $4,630.85 | $16,394.00 | $17,524.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.88 / $998.64 / $1,661.06
| Facility | AS | $223.88 | $998.64 | $1,661.06 |