- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.91 / $3,815.00 / $11,780.15
| Facility | | $628.91 | $3,815.00 | $11,780.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,441.81 / $5,142.85 / $9,195.94
| Facility | | $2,441.81 | $5,142.85 | $9,195.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.03 / $1,158.06 / $2,345.00
| Facility | | $629.03 | $1,158.06 | $2,345.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $62.30 / $62.30 / $62.30
| Facility | AS | $62.30 | $62.30 | $62.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.62 / $687.50 / $1,200.30
| Facility | | $599.62 | $687.50 | $1,200.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.33 / $94.33 / $160.08
| Facility | AS | $94.33 | $94.33 | $160.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,147.00 / $16,816.00
| Facility | | $1,981.00 | $10,147.00 | $16,816.00 |