- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.18 / $8,783.00 / $19,652.65
| Facility | | $770.18 | $8,783.00 | $19,652.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,860.32 / $10,419.11 / $18,018.52
| Facility | | $4,860.32 | $10,419.11 | $18,018.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $768.89 / $7,304.87
| Facility | | $580.00 | $768.89 | $7,304.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.39 / $76.39 / $76.39
| Facility | AS | $76.39 | $76.39 | $76.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.71 / $948.78 / $1,467.95
| Facility | | $744.71 | $948.78 | $1,467.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.77 / $137.34 / $195.69
| Facility | AS | $110.77 | $137.34 | $195.69 |
- 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 |