- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.02 / $7,968.00 / $10,276.59
| Facility | | $832.02 | $7,968.00 | $10,276.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.05 / $1,068.72 / $1,450.14
| Facility | | $670.05 | $1,068.72 | $1,450.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.65 / $165.02 / $230.54
| Facility | AS | $107.65 | $165.02 | $230.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,688.00 / $14,893.00 / $22,265.00
| Facility | | $6,688.00 | $14,893.00 | $22,265.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.13 / $17,070.15 / $26,542.00
| Facility | | $4,393.13 | $17,070.15 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $150.07 / $164.62 / $1,618.01
| Facility | AS | $150.07 | $164.62 | $1,618.01 |