- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.65 / $9,062.00 / $18,276.00
| Facility | | $818.65 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,294.50 / $7,206.40 / $12,212.57
| Facility | | $3,294.50 | $7,206.40 | $12,212.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.42 / $890.00 / $2,581.96
| Facility | | $812.42 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.87 / $80.87 / $80.87
| Facility | AS | $80.87 | $80.87 | $80.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.84 / $975.51 / $1,583.10
| Facility | | $702.84 | $975.51 | $1,583.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.84 / $145.88 / $215.62
| Facility | AS | $103.84 | $145.88 | $215.62 |
- 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 |