- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.61 / $7,799.00 / $13,335.00
| Facility | | $820.61 | $7,799.00 | $13,335.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,836.04 / $14,347.55 / $25,571.79
| Facility | | $6,836.04 | $14,347.55 | $25,571.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $814.65 / $7,482.68
| Facility | | $580.00 | $814.65 | $7,482.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.94 / $80.94 / $80.94
| Facility | AS | $80.94 | $80.94 | $80.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.11 / $969.14 / $1,565.56
| Facility | | $791.11 | $969.14 | $1,565.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $113.93 / $141.68 / $208.47
| Facility | AS | $113.93 | $141.68 | $208.47 |
- 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 |