- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.66 / $9,863.00 / $20,498.00
| Facility | | $612.66 | $9,863.00 | $20,498.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,839.91 / $11,301.77 / $19,407.11
| Facility | | $4,839.91 | $11,301.77 | $19,407.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $611.16 / $5,740.31
| Facility | | $580.00 | $611.16 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.51 / $60.51 / $60.51
| Facility | AS | $60.51 | $60.51 | $60.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.05 / $750.59 / $1,170.55
| Facility | | $602.05 | $750.59 | $1,170.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $90.17 / $108.78 / $158.53
| Facility | AS | $90.17 | $108.78 | $158.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |