- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.32 / $9,062.00 / $20,458.15
| Facility | | $875.32 | $9,062.00 | $20,458.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,011.56 / $9,829.40 / $17,877.47
| Facility | | $4,011.56 | $9,829.40 | $17,877.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $718.67 / $7,239.50
| Facility | | $580.00 | $718.67 | $7,239.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $71.28 / $71.28 / $71.28
| Facility | AS | $71.28 | $71.28 | $71.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.20 / $883.93 / $1,365.77
| Facility | | $693.20 | $883.93 | $1,365.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.14 / $136.36 / $181.93
| Facility | AS | $103.14 | $136.36 | $181.93 |
- 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 |