- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.68 / $8,783.00 / $16,467.00
| Facility | | $857.68 | $8,783.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,109.54 / $10,148.12 / $18,314.23
| Facility | | $5,109.54 | $10,148.12 | $18,314.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.80 / $890.00 / $5,740.31
| Facility | | $857.80 | $890.00 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.30 / $85.30 / $85.30
| Facility | AS | $85.30 | $85.30 | $85.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.86 / $926.08 / $1,633.44
| Facility | | $772.86 | $926.08 | $1,633.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.14 / $128.24 / $218.49
| Facility | AS | $120.14 | $128.24 | $218.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |