- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.34 / $8,237.29 / $16,467.00
| Facility | | $861.34 | $8,237.29 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.48 / $5,350.19 / $9,222.64
| Facility | | $2,143.48 | $5,350.19 | $9,222.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.48 / $1,965.14 / $2,345.00
| Facility | | $859.48 | $1,965.14 | $2,345.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.26 / $85.26 / $85.26
| Facility | AS | $85.26 | $85.26 | $85.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.86 / $954.65 / $1,657.07
| Facility | | $827.86 | $954.65 | $1,657.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $130.72 / $130.72 / $219.73
| Facility | AS | $130.72 | $130.72 | $219.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |