- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $10,471.29
| Facility | | $851.14 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,760.83 / $13,803.84
| Facility | | $3,981.07 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,000.00 / $1,288.25
| Facility | | $724.44 | $1,000.00 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,380.38 / $1,380.38
| Facility | | $34.67 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $6,760.83 / $15,488.17
| Facility | | $1,174.90 | $6,760.83 | $15,488.17 |