- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.58 / $9,047.14 / $16,467.00
| Facility | | $740.58 | $9,047.14 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,221.47 / $7,263.19 / $12,212.57
| Facility | | $3,221.47 | $7,263.19 | $12,212.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $738.76 / $7,421.75
| Facility | | $715.00 | $738.76 | $7,421.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.37 / $73.37 / $73.37
| Facility | AS | $73.37 | $73.37 | $73.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.12 / $896.10 / $1,408.87
| Facility | | $712.12 | $896.10 | $1,408.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $106.80 / $127.54 / $216.14
| Facility | AS | $106.80 | $127.54 | $216.14 |
- 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 |