- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.66 / $3,508.40 / $16,467.00
| Facility | | $568.66 | $3,508.40 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,714.49 / $6,836.09 / $11,923.62
| Facility | | $2,714.49 | $6,836.09 | $11,923.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.77 / $580.00 / $2,581.96
| Facility | | $568.77 | $580.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.45 / $56.45 / $56.45
| Facility | AS | $56.45 | $56.45 | $56.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.35 / $682.39 / $1,068.36
| Facility | | $543.35 | $682.39 | $1,068.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.59 / $104.44 / $142.19
| Facility | AS | $81.59 | $104.44 | $142.19 |
- 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 |