- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.21 / $8,876.00 / $16,677.12
| Facility | | $837.21 | $8,876.00 | $16,677.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,387.69 / $5,364.75 / $9,222.64
| Facility | | $2,387.69 | $5,364.75 | $9,222.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.32 / $1,965.14 / $2,345.00
| Facility | | $832.32 | $1,965.14 | $2,345.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.39 / $82.39 / $82.39
| Facility | AS | $82.39 | $82.39 | $82.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.29 / $935.52 / $1,609.04
| Facility | | $807.29 | $935.52 | $1,609.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.26 / $128.26 / $252.31
| Facility | AS | $128.26 | $128.26 | $252.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |