- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.32 / $7,182.00 / $22,213.02
| Facility | | $942.32 | $7,182.00 | $22,213.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,915.75 / $10,229.31 / $19,712.46
| Facility | | $2,915.75 | $10,229.31 | $19,712.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $780.00 / $5,740.31
| Facility | | $505.00 | $780.00 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $105.15 / $105.15 / $105.15
| Facility | AS | $105.15 | $105.15 | $105.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.35 / $948.00 / $1,538.49
| Facility | | $698.35 | $948.00 | $1,538.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.52 / $141.68 / $221.15
| Facility | AS | $114.52 | $141.68 | $221.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,628.00 / $17,146.00 / $24,161.00
| Facility | | $4,628.00 | $17,146.00 | $24,161.00 |