- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.28 / $1,615.00 / $7,278.00
| Facility | | $752.28 | $1,615.00 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.53 / $2,332.53 / $3,332.89
| Facility | | $2,332.53 | $2,332.53 | $3,332.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,604.38
| Facility | | $606.10 | $606.10 | $7,604.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.28 / $1,005.50 / $1,527.10
| Facility | | $752.28 | $1,005.50 | $1,527.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $130.84 / $152.61 / $252.97
| Facility | AS | $130.84 | $152.61 | $252.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $21,935.29 / $25,131.10
| Facility | | $55.00 | $21,935.29 | $25,131.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.32 / $2,382.07 / $2,382.07
| Facility | AS | $174.32 | $2,382.07 | $2,382.07 |