- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.92 / $1,007.17 / $8,229.00
| Facility | | $708.92 | $1,007.17 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,212.00 / $9,015.00 / $11,253.00
| Facility | | $7,212.00 | $9,015.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.96 / $1,146.03 / $1,322.02
| Facility | | $834.96 | $1,146.03 | $1,322.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.33 / $1,007.33 / $1,007.33
| Facility | | $1,007.33 | $1,007.33 | $1,007.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.51 / $100.51 / $100.51
| Facility | AS | $100.51 | $100.51 | $100.51 |
- 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 |