- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.57 / $9,062.00 / $18,276.00
| Facility | | $620.57 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,752.53 / $10,253.54 / $17,240.66
| Facility | | $4,752.53 | $10,253.54 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.10 / $620.10 / $890.00
| Facility | | $620.10 | $620.10 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.67 / $61.67 / $61.67
| Facility | AS | $61.67 | $61.67 | $61.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.55 / $744.68 / $1,217.84
| Facility | | $609.55 | $744.68 | $1,217.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.54 / $108.50 / $174.44
| Facility | AS | $92.54 | $108.50 | $174.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |