- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.11 / $9,062.00 / $18,276.00
| Facility | | $752.11 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.18 / $6,861.51 / $12,212.57
| Facility | | $2,803.18 | $6,861.51 | $12,212.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $748.81 / $5,740.31
| Facility | | $715.00 | $748.81 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $74.42 / $74.42 / $74.42
| Facility | AS | $74.42 | $74.42 | $74.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $726.06 / $902.53 / $1,426.77
| Facility | | $726.06 | $902.53 | $1,426.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.26 / $126.56 / $191.29
| Facility | AS | $108.26 | $126.56 | $191.29 |
- 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 |