- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.63 / $9,770.94 / $22,312.41
| Facility | | $744.63 | $9,770.94 | $22,312.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,304.16 / $6,616.56 / $11,599.21
| Facility | | $3,304.16 | $6,616.56 | $11,599.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.39 / $715.00 / $2,581.96
| Facility | | $568.39 | $715.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.48 / $56.48 / $56.48
| Facility | AS | $56.48 | $56.48 | $56.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.05 / $703.81 / $1,206.40
| Facility | | $553.05 | $703.81 | $1,206.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.37 / $99.12 / $195.71
| Facility | AS | $82.37 | $99.12 | $195.71 |
- 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 |