- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.16 / $9,062.00 / $18,276.00
| Facility | | $626.16 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.29 / $625.29 / $890.00
| Facility | | $625.29 | $625.29 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $62.19 / $62.19 / $62.19
| Facility | AS | $62.19 | $62.19 | $62.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.30 / $770.50 / $1,188.84
| Facility | | $609.30 | $770.50 | $1,188.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.20 / $115.36 / $160.93
| Facility | AS | $95.20 | $115.36 | $160.93 |
- 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 |