- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.00 / $1,047.93 / $10,152.00
| Facility | | $896.00 | $1,047.93 | $10,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $3,967.00 / $8,800.00
| Facility | | $2,088.00 | $3,967.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.30 / $1,188.31 / $1,370.79
| Facility | | $866.30 | $1,188.31 | $1,370.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.37 / $1,041.89 / $1,041.89
| Facility | | $882.37 | $1,041.89 | $1,041.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.74 / $101.74 / $101.74
| Facility | AS | $101.74 | $101.74 | $101.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |