- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.76 / $9,062.00 / $20,498.00
| Facility | | $853.76 | $9,062.00 | $20,498.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.76 / $845.76 / $890.00
| Facility | | $845.76 | $845.76 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.03 / $84.03 / $84.03
| Facility | AS | $84.03 | $84.03 | $84.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.21 / $1,024.51 / $1,635.72
| Facility | | $777.21 | $1,024.51 | $1,635.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.38 / $154.13 / $218.73
| Facility | AS | $119.38 | $154.13 | $218.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |