- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.84 / $1,718.76 / $8,681.31
| Facility | | $856.84 | $1,718.76 | $8,681.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $9,458.00 / $17,400.00
| Facility | | $8,512.20 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.76 / $2,472.40 / $2,558.92
| Facility | | $847.76 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.37 / $84.37 / $84.37
| Facility | AS | $84.37 | $84.37 | $84.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,155.00 / $11,155.00 / $11,155.00
| Facility | | $11,155.00 | $11,155.00 | $11,155.00 |