- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.82 / $1,284.30 / $8,413.00
| Facility | | $861.82 | $1,284.30 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.39 / $1,863.39 / $2,662.55
| Facility | | $1,863.39 | $1,863.39 | $2,662.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.82 / $1,120.36 / $1,791.39
| Facility | | $861.82 | $1,120.36 | $1,791.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.97 / $192.50 / $272.68
| Facility | AS | $140.97 | $192.50 | $272.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,221.00 / $8,957.00 / $26,542.00
| Facility | | $3,221.00 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.51 / $510.42 / $849.00
| Facility | AS | $199.51 | $510.42 | $849.00 |