- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.70 / $7,182.00 / $14,548.88
| Facility | | $792.70 | $7,182.00 | $14,548.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,109.56 / $10,148.12 / $18,360.62
| Facility | | $4,109.56 | $10,148.12 | $18,360.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $780.00 / $2,581.96
| Facility | | $505.00 | $780.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $78.29 / $78.29 / $78.29
| Facility | AS | $78.29 | $78.29 | $78.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $945.33 / $1,513.72
| Facility | | $736.00 | $945.33 | $1,513.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.05 / $136.08 / $202.03
| Facility | AS | $110.05 | $136.08 | $202.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |