- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.68 / $4,230.00 / $9,870.00
| Facility | | $854.68 | $4,230.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,041.58 / $6,454.34 / $11,190.33
| Facility | | $3,041.58 | $6,454.34 | $11,190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $580.00 / $2,581.96
| Facility | | $375.00 | $580.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.30 / $84.30 / $84.30
| Facility | AS | $84.30 | $84.30 | $84.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.47 / $996.35 / $1,506.08
| Facility | | $767.47 | $996.35 | $1,506.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.61 / $149.57 / $200.19
| Facility | AS | $114.61 | $149.57 | $200.19 |
- 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 |