- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.30 / $9,062.00 / $20,498.00
| Facility | | $681.30 | $9,062.00 | $20,498.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,544.63 / $11,285.43 / $19,407.11
| Facility | | $5,544.63 | $11,285.43 | $19,407.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $678.50 / $2,581.96
| Facility | | $580.00 | $678.50 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.22 / $67.22 / $67.22
| Facility | AS | $67.22 | $67.22 | $67.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.39 / $843.93 / $1,286.63
| Facility | | $656.39 | $843.93 | $1,286.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $98.66 / $118.72 / $194.18
| Facility | AS | $98.66 | $118.72 | $194.18 |
- 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 |