- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.87 / $2,480.62 / $19,805.99
| Facility | | $830.87 | $2,480.62 | $19,805.99 |
- 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
- $822.46 / $2,000.36 / $2,070.38
| Facility | | $822.46 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.76 / $81.76 / $81.76
| Facility | AS | $81.76 | $81.76 | $81.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,399.00 / $12,399.00 / $12,399.00
| Facility | | $12,399.00 | $12,399.00 | $12,399.00 |